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Department of the Inteeiok 
BauFAO OP Health 



History and Description 



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Maiuia . 
Pliilippiae Islands 
. 1900 to 1911 



Coropi',eti.by 
lOHN E. SNODGRASS, M.'D, 

uo-der the directioh of 
the Aclhig Director of. Heaith 

DR. CARROLL FOX 

October, 191) 



107997 



MANILA. 

BlIEEAU OF PRINTING 

1912 



CORNELLUNIVEKSirY 

LIBRARY 

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The original of tiiis book is in 
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There are no known copyright restrictions in 
the United States on the use of the text. 



http://www.archive.org/details/cu31924063266534 



Department of the Interior 
Bureau of Health 



History and Description ' 

of the 

Philippine General 
Hospital 



Manila 

Philippine Islands 

1900 to 1911 



Compiled by 
JOHN E. SNODGRASS, M. D. 

under the direction of 
the Acting Director of Health 

DR. CARROLL FOX 

October, 1911 



MANILA 
BUREAU OF PRINTING 
1912 
107997 



FOREWORD. 



In writing a history of the magnificent new hospital which now 
adorns Taft Avenue, Manila, it is proper to state, at the outset, 
that a lion's share of the credit for its erection is due the 
Honorable Dean C. Worcester, Secretary of the Interior, as it 
is extremely doubtful whether the hospital, in its present propor- 
tions and grandeur at least, could have been built without his 
unflagging interest and tenacity of purpose. 

As a result of ten years of hard work and persistent effort on 
the part of Government officials and laity, Manila possesses a 
hospital which compares favorably with the best hospitals of the 
world and which is already proving a veritable godsend to the 
people of the Islands. Although it has been in operation only 
a short time it is apparent that more space will be required in 
the near future. Applicants for admission have to be turned 
away almost daily. The fact that the Filipinos are clamoring for 
more room clearly indicates that the right note has been struck, 
and that the hospital is going to prove of incalculable and lasting 
benefit to the Philippines. 

Many other persons deserve special credit for their efforts 
toward the building of the hospital. More prominent among 
these are President Taft, Governor-General Forbes, Dr. J. R. 
McDill, former Commissioner of Health Major E. C. Carter, and 
the present Director of Health Dr. Victor G. Heiser. 

Much difficulty has been experienced in collecting the necessary 
facts and data for this publication and the writer wishes to make 
acknowledgment of the material assistance rendered by the 
acting superintendent of the hospital, Mr. Newton C. Comfort, the 
chief accountant of the Bureau of Public Works, Mr. J. Pickering, 
the acting chief of building maintenance. Bureau of Public Works, 
Mr. Lewis Cook, and others who took part in the building of the 
hospital or are at present connected with the management of the 
institution. 

John E. Snodgrass, 

Bureau of Health. 

Manila, P. I., October 1,1911. 

3 



HISTORY AND DESCRIPTION OF THE PHILIP- 
PINE GENERAL HOSPITAL. 



HISTORICAL. 



In the year 1900, prior to the establishment of the Civil Gov- 
ernment in the Philippine Islands, and shortly after the arrival 
on the ground of the Second Philippine Commission, commonly 
known as the "Taft Commission," Dean C. Worcester, who was 
then a member of the Commission and who had held the position 
of Secretary of the Interior since the establishment of the Execu- 
tive Departments of the Insular Government, formulated a plan 
for the establishment in Manila of Central Government labora- 
tories for the performance of routine work and original scientific 
research, of a medical college, and of a General Hospital, all to 
be located as near each other as practicable, upon a lot large 
enough to provide for all probable future expansion, the three 
institutions to be so interrelated that the Government laboratories 
might do routine work for the hospital and at the same time carry 
on original research relative to the causation and relief of disease, 
utilizing for the latter purpose material furnished by the hospital ; 
that the laboratory staff might be available for teaching in the 
medical school and for service in the hospital ; that the students 
of the medical school might have abundant opportunity for 
practical instruction in the hospital wards and clinics; and that 
the members of the teaching staff of the medical college might 
have opportunity not only to aid in the hospital work but to carry 
on their own original investigations in the laboratory. 

The realization of this project seemed so improbable that its 
originator was called "crazy," while the plan itself was commonly 
designated as "Worcester's dream." The first step toward its 
realization was taken when the Bureau of Government Labo- 
ratories was established on July 1, 1901, by the passage of an 
act which provided for the centralization of all the biological and 
chemical work of the Insular Government. A further and great 
advance was made when the Philippine Bureau of Science, into 
which the Bureau of Government Laboratories ultimately devel- 
oped, occupied the carefully planned and well equipped laboratory 
building constructed for its special use. This building was 
erected on the so-called Exposition Grounds which afforded a 

5 



conveniently situated site of sufficient size to accommodate all 
of the buildings needful for a medical school and for a hospital 
of a thousand or more beds, but at the outset other plans were 
entertained relative to the future of that portion of the land in 
this tract not needed by the Bureau of Science, and it was only 
after a long and determined contest that its reservation for a 
hospital and a medical school was secured. Then followed the 
establishment of the medical school itself, which was provided 
for by a law enacted on December 1, 1905. The school was at 
first, of necessity, given temporary quarters pending the construc- 
tion of a suitable home for it. The medical school building, which 
stands on the Exposition Grounds immediately to the west of the 
building of the Bureau of Science, was occupied on June 1, 1910. 

The completion and occupation of the splendid group of rein- 
forced concrete buildings which now constitute the Philippine 
General Hospital marked the full realization of "Worcester's 
dream." 

President Taft, the first American Civil Governor of the Phil- 
ippine Islands, favored this project from the start. On Novem- 
ber 30, 1907, immediately after a visit to the Philippines, he 
wrote Secretary Worcester as follows: 

My own impression is that it would be much better if the Medical School 
were included in your Department of Sanitation. There, I think, is where 
it properly belongs, and as you have the laboratory and will have the hos- 
pital, it seems to me that the school should be under the same head. There 
is not the slightest reason why it should be embraced in the Education 
Department. I regard the school as of the highest importance in the devel- 
opment of the Philippines and to furnish to the inhabitants a basis for 
more reasonable living and great physical development. I don't think that 
there is anything that we have on hand more important than to develop the 
Filipinos physically. I know it can be done if the improvements in the 
water supply, and in food, and in proper hygiene can be given proper appli- 
cation. The school, therefore, in spreading an evangel of decent, healthful 
living through its graduates is more of a sanitary than it is of an educa- 
tional character. // / could visit the Philippines again in two years, I 
should hope to see your hospital and your medical school and your labora- 
tory all running close together, and that ideaf which you have painted in 
words so often in the Commission will then be realized. 

Secretary Worcester has never sought to gain control of the 
College of Medicine and Surgery, which to-day forms an integral 
part of the Philippine University, but has successfully endeavored 
to bring about a practical working relationship between this 
college, the Bureau of Science, and the Philippine General Hos- 
pital, such that these three institutions might mutually assist 
each other and might constitute an ideal combination for the 
investigation and the combating of disease. Were President Taft 
to visit the Philippines to-day, he would see the Medical School, 




OLD CIVIL HOSPITAL. 




OLD LABORATORY BUILDING. 
PLATK II. 




BUREAU OF SCIENCE. 




COLLEGE OF MEDICINE AND SURGERY. 
PLATE 111. 



the Hospital, and the Laboratory running "close together," not 
only in geographic situation but in harmony and community of 
interest. 

It is with the history of the General Hospital that the writer 
is chiefly concerned. President Taft's interest in this great 
hospital is by no means of recent date. While President of the 
Philippine Commission, and prior to his appointment as Civil 
Governor of the Philippines, he requested Maj. John R. McDill, 
U. S. v., to present recommendations looking toward the estab- 
lishment of a General Hospital in Manila. The report of Major 
McDill made in reply to this request follows : 

First Reserve Hospital, 
Manila, P. I. 

November 12th, 1900. 
To the Honorable Wm. H. Taft, 

President Civil Commission, Philippine Islands, Manila, P. I. 

Sir: In compliance with your request I have the honor to make recom- 
mendations based upon the following brief statements concerning a general 
hospital for Manila, P. I. 

The most useful hospitals are general ones, built upon the pavilion plan, 
with ample acreage and good management, under competent medical direc- 
tion. It should combine a school of instruction for male and female nurses; 
the material should be accessible, under proper restrictions, to students of 
medicine and it should be a center for the scientific investigation of disease. 
In the present state of our knowledge of hospital construction, hygiene and 
the true principles of health such a hospital could be made a blessing and 
a benefit to rich and poor, as well as a safeguard and defense to the public 
health. The broad general object of hospitals may be stated to be the 
gratuitous medical and surgical treatment of indigent sick. There is a 
large class, however, above the very poor who are but ill able to afford 
skilled attendance and nursing at their homes. It is not desirable, nor is 
it always their own wish that these persons should be objects of charity 
and the establishment of paying departments meet this difflculty to some 
extent; However, if it is accomplished it should be done with fairness to 
other hospitals and to all concerned, and paying patients should have the 
medical man of their choice, and every physician should be, as far as his 
patient is concerned, in such a hospital a free, independent, responsible 
agent, enjoying equal rights with all as far as consistent with wise manage- 
ment. A cardinal principle to be observed in such a hospital is that it shall 
do as little harm as possible. There is always a certain danger of pro- 
moting in free hospitals negligence, shiftlessness, laziness, and vice by 
offering free relief from their consequences. This is a" danger connected 
with the management and can be guarded against. 

The only differences to be considered in constructing a hospital in Manila 
and one elsewhere are connected with the climate' and classes of disease 
encountered.' The construction is vastly simpler here than in temperate 
climes; the great subject of heating and artificial ventilation and their 
attendant expenses do not figure here at all. The provision in a general 
hospital for Manila against infectious diseases is primarily a defensive 
measure and demands immediate and most serious consideration. Means 
must be provided of isolating at once the earliest cases of epidemic disease. 



8 

Hours could be occupied in relating instances in which epidemics have 
evidently been prevented by the isolation of first cases of infectious disease. 
The necessity of these sanitary defenses is, therefore, exceedingly clear. 

A hospital built in these days and under the direction of your commission 
which is so absolutely free from local political influences should have fewer 
objections to its plan than any Government hospital hitherto constructed; 
by avoidance of objects of expedience, of cheapness, or ornament and erected 
with the design of subserving all the interests of modern scientific achieve- 
ments as well as the interests of patients and physicians. 

The controlling idea in founding such institutions, unhampered by any 
misapplied notions of benevolence or necessity of economy should be the 
practical application of sanitary science in treating the sick; as it is well 
known that absurd and mistaken economy has often rendered pious labor 
and expense in a great measure not only useless but even fatal and destruc- 
tive to its very aim and endi 

SYSTEM OP BUILDING. 

Of the two systems of building to choose from only the pavilion can be 
considered. This is the arrangement of a number of buildings, in which 
wards, administration, attendance, help, kitchens, and various parts of the 
economy are separated. This is in antithesis or contrast to the corridor 
system, a system of decentralization of the individual parts of a hospital. 

ESTIMATE OF NUMBER NEEDING HOSPITAL CAKE. 

A question of primary importance to you is, how many beds are re- 
quired. To the consideration of this subject can be brought experience 
concerning the general relation of the number of sick to the population 
of various places, as modified by the situation of the hospital and the 
climatic conditions; further, the principal occupations and general health 
conditions of a city's inhabitants, as well as the proximity of other institu- 
tions for the sick and many local factors. Not the least of these is that 
future management and arrangements of a hospital, to be founded now, 
can and should be such as to inspire confidence in the people as to its 
great necessity and benefit to health and thereby cause it to be used by 
all classes in time of sickness. 

As far as this general experience is concerned. Plage estimated upon 
the basis of Husson's investigations that, according to the number of sick 
received in the Parisian hospitals and the number of days spent by the 
sick in hospital, for each one thousand inhabitants about five beds were 
used. Essentially less is the calculation by Douglas C. Galton on the 
general hospitals of London, exclusive, of course, of hospitals for infec- 
tious disease, which is about one bed to one thousand inhabitants. This last 
proportion, for general and surgical cases, Galton, in conformity with 
the view of Burdett, Waring, and others, says can be regarded as the 
standard sick bed necessity of English municipalities. In addition, Bur- 
dett insists that for districts with mines, great shops and the like, four to 
five beds for each one thousand people should be provided. Oppert finds 
that for large cities with extensive poor districts about four beds per 
thousand are needed. According to a computation on the basis of the 
statements of the statistical "Jahrbuch" of German cities, Hamburg in 
1890 used for each one thousand inhabitants about five beds, this included 
all of the general hospitals for every purpose. Berlin used about four 
beds, Cologne five and seven-tenths, Stuttgart six beds, Potsdam six and 
eight-tenths beds, Breslau four beds, and Dresden three and three-tenths 



beds. Therefore, for large cities space for hospital accommodations of at 
least five beds to each one thousand inhabitants should be provided, es- 
pecially as hospitals are in these times far better understood and appreci- 
ated and far more taken advantage of than formerly. 

Thus far it is assumed that these estimates were entirely based on the 
use made of hospitals by the poorer classes. Should paying patients be 
admitted the beds for such are to be provided in addition. 

In deciding the extent of area of a new hospital it is necessary to 
consider not only the present need, but there must be a certain reserve 
space, which future increase in population will require, as well so as to 
be prepared for special emergencies, like epidemics and great disasters 
from storms, floods, or fire. 

SIZE OF A HOSPITAL. 

Although many authorities have laid it down that no hospital should 
house more than five hundred patients, the great example of the "Hamburg- 
Eppendorf" pavilion hospital of fifteen hundred beds, where every detail 
of administration, service, and of attention to hygiene is carried out to 
perfection, shows the possibilities of modern methods and science in hos- 
pital construction, organization, and management. 

SIZE, LOCATION AND NATURE OF A HOSPITAL SITE OK GROUND AREA. 

Primary requisites; pure and fresh air; sufficient elevation for drainage; 
pure soil; accessibility by water and wheel transportation, and for pavilion 
hospitals about 100 square meters (120 square yards) per bed for a 
hospital of one hundred beds. 

This surface area should increase with the number of beds until a 600- 
bed hospital would have about 150 square meters per bed, or namely 
fifty beds to the acre. One acre equals about 4,050 square meters. 

Infection hospitals need a greater area or thirty to forty beds to the 
acre. 

The average ground area of the following-named hospitals of a total 
of 6,370 beds is 132 square meters. Square 

Beds. meters. 

Hamburg-Eppendorf 1,500.... 124 

Friedrichshian 784.... 122 

Heidelberg 360.... 110 

Ruldolfspital, Wien 800.... 43 

Lariboisiere, Paris 612.... 82 

St. Louis, Paris 700.... 130 

Montpellier 600.... 150 

Zurich 500.... 160 

Kopenhagen 312.... 280 

Johns Hopkins 400.... 140 

The Kinderspital of Moskau of 180 beds has an average ground area 
of 782 square meters per bed. 

When sites of general hospitals are too distant from the center of 
population for the transport of emergency or cases needing immediate 
care, a most desirable and necessary adjunct is a centrally located emer- 
gency hospital. , 

BUILDING PROGRAM. 

As before stated, there should be discussed here only a general pavilion 
hospital with a department, either on the general same site or remote, for 
infectious diseases. 



10 

Incurables, the insane, lepers, and pulmonary tuberculosis should be cared 
for in separate institutions, in special localities. 

By a general hospital is meant one with departments for all medical, 
surgical, and lying-in, eye and ear, and children's diseases. 

1. A building should be set aside for the nurses on duty and under 
training. 

2. A building for clinical instruction of students of medicine is one of 
the obligations of every modern public hospital. 

3. In the disposition of the space the sick must be grouped by separation 
of the sexes and then further according to the nature of the diseases. 

4. When paying patients are to be admitted their buildings should lie 
together. 

5. A two-story or corridor building might be found desirable for the 
segregation of syphilis, venereal and contagious skin diseases which are 
usually separated from the main body of a hospital more on disciplinary 
than medical grounds. 

Each general hospital, aside from the contagious department, divides 
into two principal sections — surgical and medical. 

This allows of the most convenient grounding of buildings and of the 
arrangement for the best care of the sick and the best work of the medical 
staff. 

Accordingly the following chief grouping of the sick and their separation 
in the building program must be kept in view : 

1. Surgical Department including eye and ear, gynecology, and so forth. 

2. Medical Department. 

3. Obstetrical Department. 

4. Department for acute infectious disease as scarlet fever, measles, 
mumps, typhus, cholera, smallpox, plague, pyaemia, 'erysipelas, diphtheria, 
and hospital gangrene. 

It is very difficult to determine even approximately the number of beds 
required for each group of diseases which fluctuates so markedly. Plage 
has, however, arranged a procentum scale for a 300-bed hospital which as 
applied to Germany and the continent is instructive. 

Each large general hospital should have a detention house for acute 
manias, violent delirium tremens, objects of disgust, as sexual perverts and 
sick prisoners. 

The capacity of ward buildings should range from four to sixty beds 
each. Each ward should have one or more separate or private rooms, a day 
room, bath, closets, etc. 

Every detail of construction, furnishing and arrangement of buildings 
one to the other can be now planned before hand so that plans and specifica- 
tions can be drawn upon which a contract can be let that will not need 
any important alteration or change. 

THE ISOLATION HOSPITAL OR DEPARTMENT. 

Of supreme importance is the pathological laboratory and experiment 
station for the scientific investigation of contagious and epidemic disease, 
as the chief feature of the isolation hospital. The necessity of isolation 
hospitals for contagious disease and which are primarily defensive, is too 
absolute to require argument. With a favorable and accessible site of 
suflncient area, the question of cost of barrack and tent hospitals for great 
emergencies can be briefly dismissed as being about one-fourth that of a 
permanent hospital. The pathological institute, however, and its wards 
to accommodate about 100 beds should be permanent structures. Such an 



11 

arrangement of an isolation hospital combined with a perfectly equipped 
bacteriological and pathological laboratory and observation wards would be 
one of the most important in the world and could benefit mankind as has 
the celebrated Koch Institute of Berlin, established by the German Govern- 
ment and the Kitasato Laboratory of the University of Japan. 

In a coast city like Manila, exposed to epidemic disease, there should be 
preparation always to furnish without much delay floating river or harbor 
hospitals in addition to the above accommodations. 

COST OP SUBSISTENCE AND RUNNING EXPENSES. 

Subsistence of native patients and native employees it is thought would 
not cost above 20 cents gold per day. The pay of attendants and employees, 
who should be mostly natives, is about one-half that in America or Euro- 
pean countries or even that of the enlisted men of the Hospital Corps 
in the United States Army. 

Competent medical and administrative officers will cost as much or 
more than paid by the army or civil institutions at home. 

Once a medical college is established by the Government the graduates 
can be used as assistants and they are glad to serve one year for the 
experience. Such positions are obtained by competitive examinations and 
are highly prized. 

It will be interesting to knojv the expense of a military hospital in 
Manila. Military Hospital No. 1, now a 400-bed hospital, costs the War 
Department about as follows for one year: 

U. S. currency. 

Salaries of seven medical officers who are also officers.. $15,000 
Pay of one hundred enlisted men of the Hospital 

Corps 26,500 

Pay of twenty-six women nurses 16,000 

Pay of forty-five civilian employees 10,000 

Cost of rations for above 10,000 

Cost of medicines and surgical dressings 6,000 

If 400 beds are filled at 35 cents per day for sub- 

sistoT! . 51,500 

Total 135,000 

Average cost per patient per day 82J cents. 

Later estimates make cost $1.50 U. S. currency. 

A civil hospital of the same capacity with native labor and other at- 
tendants, officered by American medical men and with about seven first 
class trained women nurses and a matron would cost approximately as 
follows, for one year: 

U. S. currency. 

Four medical and administrative officers $10,000 

One hundred nurses, attendants, etc 15,000 

Seven trained women nurses and one matron 4,000 

Forty laborers, teamsters, etc 3,000 

Subsistence of above 6,000 

Medicines, etc 5,000 

Four hundred beds at 20 cents per day 29,000 

Total : 72,000 

Average cost per day per patient, about 50 cents gold for native patients. 



12 

COST OP BUILDING AND FURNISHINGS. 

Construction costs naturally vary greatly in different countries and are 
governed by prices of material, labor, and style of building for diiferent 
climates. Aside from the cost of the grounds, their ornamentation and 
the roads leading to and around them, simplicity or richness of the build- 
ings, the size and style of construction, cause an important difference in 
the cost per bed. In addition to the estimate submitted herewith of cost 
of construction in Manila, showing cost per bed to be from $400 to $500 
United States currency, the following list is instructive as showing the 
cost per bed of various large hospitals : 

Lariboisiere, Paris, 612 beds, per bed, $3,250, including cost of grounds, 
buildings and furnishings. 

The following costs per bed are exclusive of ground and furnishings : 

Hotel Dieu, Paris, 566 beds (corridor) $3,000 

St. Thomas, London, 588 beds (corridor) 3,250 

Without the heavy and extensive foundations neces- 
sary 1,250 

Antwerp Civil Hospital, 380 beds (semi-corridor) 1,800 

John Hopkins, Baltimore, 400 beds (pavilion) 4,000 

Friedrichshain, Berlin, 620 beds (pavilion) 1,680 

Am Urban, Berlin, 600 beds (pavilion) 1,075 

Hamburg-Oppendorf, 1,600 beds (pavilion) 875 

Dresden Children's Hospital, 114 beds (pavilion) 1,050 

Kronprinz Rudolf, Wien, 800 beds, combination corridor 

and pavilion 1,600 

Offenbach Hospital, 250 beds (pavilion) 850 

The more the decentralization of the parts of a hospital are carried out, 
the higher the cost. Combination corridor and pavilion hospitals of modern 
build require in other countries about $750 per bed and the larger hospitals 
on the pavilion plan about $1,000 per bed, and this by avoidance of unneces- 
sary luxury in detail. 

It is also obvious that the more the sick are divided in separate buildings, 
the greater the cost per bed. For instance : the two-story pavilions at Ham- 
burg of seventy-two beds, per bed $375. The one-story pavilions at Ham- 
burg of thirty-three beds, per bed, $450. The one-story pavilions at 
Hamburg of fifteen beds, per bed 



NECESSARY FURNISHINGS. 

In an entirely new institution, the general necessary furniture and fix- 
tures without instruments will require an outlay of from $100 to $150 per 
bed. The latter sum is scarcely ever exceeded in the most richly equipped 
hospitals. The average interior furnishing cost, including the instruments, 
is much the same everywhere and can be estimated for Manila from the 
following modemly outfitted hospitals : 

Hamburg-Eppendorf, per bed *]^gg 

Friedrichshain, per bed -tAQ 

Am Urban, per bed -j^i^q 

Eudolfspital "Wien, per bed 105 

Considering the cost of transportation, breakage, etc., $200 per bed should 
be allowed for a Manila hospital. 



13 



RECOMMENDATIONS. 



1. That acreage as central and accessible as possible be secured for a 
1,500-bed pavilion general hospital. This would require about forty acres. 
Also acreage for 100-bed infectious disease hospital of permanent construc- 
tion with space about it for 300 patients in tents or barracks in event of a 
great epidemic; this would require about fifty acres of ground. This 
area would meet all future needs of Manila for many years as far as 
hospital sites are concerned. 

2. That upon the basis of the population, etc., funds be provided for 
constructing a 1,000 or 1,500 bed general pavilion hospital at the rate of 
300 beds per year, and that the permanent buildings of the infectious 
disease hospital and its laboratory and experimental station be completed as 
soon as possible. 

3. That, pending your action on a plermanent hospital, arrangements 
be made with the San Juan de Dios Hospital for 150 beds to be used for the 
present emergency needs of the city; or, if this is found to be impracticable, 
that a suitable large building, preferably in the Walled City, be rented and 
equipped as the Manila emergency hospital, and that the work of training 
native Filipina girls as nurses be started in connection with it at once. 

Very respectfully, 

(Sgd.) John R. McDill, 
Major and Surgeon, U. S. V., 
Operating Surgeon, 1st Reserve Hospital. 

Toward the end of the year 1900 the Philippine Civil Com- 
mission began to take an active interest in the agitation for the 
hospital, and on January 23, 1901, passed the following resolution 
which was transmitted to Major General Mc Arthur, at that time 
Military Governor of the Islands : 

Resolved that the Commission wishes, if practicable, to establish a gen- 
eral municipal hospital in this city, with a capacity of three hundred beds 
or more, for the use of the civil servants of the Insular Government and 
the white and native population of Manila and the Islands. With a view to 
the execution of this purpose the president is directed to communicate with 
the Military Governor, and learn from him whether the building now used 
as a second reserve hospital can be turned over to the civil authorities of 
Manila to be used as a general civil hospital, and whether the equipment of 
the second reserve hospital could be transferred to the Insular Government 
upon the payment of a reasonable sum therefor to be fixed by a board of 
competent officers and physicians; and to inquire further upon what terms 
the building now occupied as the second reserve hospital, and the land upon 
which it. stands, is held by the Government, and whether the terms of the 
lease, if any, would permit a transfer from the United States to the Insular 
Government. 

Immediately after the arrival of the American army in the 
Islands military hospitals were established in Manila. The mili- 
tary medical corps extended the courtesies of the army hospitals 
to civilians when it was possible to do so but, of necessity, this 
service was highly unsatisfactory to the citizens of Manila. 

In spite of the efforts made to establish a hospital for the ac- 



14 

commodation of civilians, this state of affairs continued until the 
month of March, 1901, when the situation was somewhat relieved 
by the establishment of the Women's Hospital at 350 Gral. Solano. 
This institution was intended, primarily, for the accommodation 
of women and children only, but in urgent cases men were 
admitted also. 

A short time after this an agreement was reached between the 
hospital authorities and the Government officials, whereby Civil 
Government employees were to be given medical and surgical 
attendance in this institution, but, unfortunately, it was soon 
discovered that the facilities here were inadequate to meet the 
demands of the situation ; moreover, the American population was 
rapidly increasing, which made it imperative that other accom- 
modations be provided. 

The first step toward relieving the situation was taken on 
August 6, 1901, when the Philippine Commission, by the passage 
of Act No. 189, made it incumbent upon the Civil Government 
to render medical assistance to its employees and their families. 
This provision was followed, on October 1, 1901, by the passage 
of Act No. 247, which established the Philippine Civil Hospital. 
The need for the hospital was so great that the necessary equip- 
ment was quickly procured and the institution opened within the 
month, in a part of the buildings on Calle Iris in which it was 
located at the time it was abolished on the opening of the General 
Hospital in 1910. 

In the meantime the Women's Hospital had been merged with 
the Cosmopolitan Hospital for which subscriptions had been 
raised and a building erected. Elaborate plans were made for 
expansion but at the critical period enthusiasm waned, and, 
partly due to the fact that patients were now being treated very 
cheaply at the Civil Hospital, the project was abandoned in 
December 1902. This building is the present City Hall. 

The Civil Hospital rate for Government employees was placed 
at T2 per day for wards and T5 for private rooms, (one peso, 
T, is equal to 50 cents U. S. currency) and accommodations 
were furnished at T=3 per day for wards and ¥=6 for private 
rooms to those not in the employ of the Government. It cost 
the Government an average of about ¥=8.50 per person per day 
for all patients for subsistence, quarters, and attendance. 

It was realized that the hospital was badly located and poorly 
suited to its needs in many ways, but at this time it was prac- 
tically impossible to obtain satisfactory buildings. Then again 
it was only intended as a temporary location, as the original in- 
tention to build a large general hospital had by no means been 
abandoned. 



15 

That the citizens of Manila had not given up the idea and that 
the question was to them a very live one was evinced by a petition 
to the Governor and Commission in the early part of 1903. 

This petition was signed by people from all walks of life in 
Manila. The major part of the petition is reproduced below: 

PETITION WITH PREAMBLE TO HIS EXCELLENCY THE GOVERNOR OP THE PHILIP- 
PINE ISLANDS AND THE HONORABLE MEMBERS OF THE CIVIL COMMISSION 
ASKING FOR THE IMMEDIATE ESTABLISHMENT IN THE CITY OP, MANILA OP 
A GENERAL HOSPITAL. 1903 

The need of a general hospital in the city of Manila, where citizens 
and ratepayers may receive medical and surgical treatment without dis- 
crimination or preference is a pressing one. Of the existing hospitals, 
San Juan de Dies, though it has 150 free beds, for which the Insular 
Government makes some provision, is a private institution; furthermore, 
it is poorly situated, and, however great its desire might be, it could not 
begin to cope v^ith the needs of the case: the Civil Hospital, though it has 
received others than those in the civil employ in the past, was established 
for the express purpose of providing for the needs of Civil servants, and it 
has neither the accommodation nor the opportunity for a work such as in 
the judgment of your petitioners the situation demands; again, the army 
hospitals are for soldiers only and are not open to the general public; and 
lastly, the voluntary enterprise known hitherto as the Women's and now 
as the Cosmopolitan Hospital is a financial failure. As an illustration, 
however, of the need of a general hospital, appended to this petition is a 
brief statisticial report of said Women's or Cosmopolitan Hospital. 

It is obvious, both from our experience in Manila as well as from the 
history of such institutions in the United States, that any further attempt 
to establish a voluntary hospital would be ill-advised. Unless at the outset 
liberal endowments were forthcoming, such an endowment as we could 
not hope to secure, the most earnest effort would be destined to speedy 
failure. The shifting population of the Philippine Islands, and the serious, 
if not insurmountable difficulty of arousing and sustaining interest among 
our fellow-citizens at home in a voluntary hospital in Manila, make the 
raising of even a modest sum of money a practical impossibility. This 
uncomfortable but undeniable fact necessitates the reluctant abandonment 
on the part of those who have been active, in the matter, of their plans for 
the reconstruction of the Woman's as the Cosmopolitan Hospital. Some- 
thing wholly inadequate might be established and made to drag out a weary 
existence on a voluntary basis, but what is needed is not merely a hospital 
where a public dispensary and a staff of competent physicians, surgeons, 
and nurses would minister to outpatients, where the best equipment and 
skill would provide for the needs of inpatients, and where sooner or later 
a training school for nurses would give Filipinos and others an opportunity 
to secure training as is found in home hospitals. 

We would base our petition, however, not merely on the fact that a 
voluntary effort has been tried and found wanting, but also and chiefly 
on our rights as citizens and ratepayers. It is recognized, and justly so, 
by the Insular Government that Civil servants should have ample provision 
made for them in case of sickness. But is it not so that we, who are sharing 
in no inconsiderable degree in the expense of the Government, should have 
a place provided for us when, in this country of sudden, serious, and obscure 
diseases, we chance to fall ill, especially as the majority of our American 



16 

citizens and of English and other ratepayers would be only too thankful 
to pay any reasonable rate for treatment if they had a hospital to which 
they were eligible? In the cities of the home land citizens demand this as 
a right to which they are entitled by virtue of their citizenship. It may 
be added here that while a voluntary hospital might struggle in vain for 
funds, an institution founded as we propose would be the recipient of gifts 
for endowment through bequests and otherwise, if the experience of general 
and city hospitals in America affords any sort of guide to what we might 
expect. 

But once more. Behind our selfish needs, which after all are relatively 
small as compared with those of whom we would speak, rises the great 
army of the suffering and uncared for poor who, at the present moment, 
think of a hospital with horror as a dishonor, just as the same class used 
to do in the cities of America. It is for these we plead. However valuable 
the work of the Board of Health physicians may be, without a general 
hospital and a public dispensary, it is greatly handicapped. The work of 
mercy that could be done for this vast population of sufferers by a hospital 
equipped and manned as well as the science of to-day knows how, would 
seem to be as immediate and as imperative a duty as any political service 
that could be rendered. 

Your petitioners wish to make it clear that in such a project as they 
have in mind, they are proposing nothing novel or revolutionary; they are 
but following a course that has long since been approved in every enlightened 
community. In all considerable cities in America the municipal government 
has recognized it to be a duty to establish and subsidize a general or city 
hospital with public and private wards. While voluntary gifts are ex- 
pected and may aid in the foundation and maintenance of such an institution, 
it is broadly conceded that a hospital is a necessity not a luxury, both as 
a safeguard for, and as a right of, the community; and that the public 
funds, that is to say the money of the people contributed to the municipal 
treasury through taxation, should make the main provision for its creation 
and support. Furthermore, such institutions for the people are placed by 
the authorities in the hands of the people for administration through the 
agency of a board of trustees, consisting of representative citizens duly 
appointed. All this is a commonplace in American cities and there is no 
need of enlarging upon it. Sooner or later a general hospital will be 
established in this city as a matter of course, and all this petition aims 
at is to hasten the day, on the grounds of the urgency of the need and the 
economy of valuable lives in immediate action. 

In order that the matter may come before your honorable body in as 
concrete shape as possible, your petitioners, in addition to stating the broad 
outlines of their desires, have appended by way of suggestion, the Acts 
and Ordinances relative to the establishment of the Boston City Hospital. 

In view of the foregoing and other considerations, your petitioners re- 
spectfully ask the acting Municipal Government of the city of Manila, that 
is to say the Insular Government : 

1. That a General Hospital be established in the city of Manila at the 
earliest moment practicable. 

2. That the existing Civil Hospital be merged into the said General 
Hospital, with such provision for the separate care of Civil employees as 
may be deemed expedient. This is suggested as a matter of economy and 
as indicating how it would be possible to achieve the end in view without 
an unwarranted increase of expenditure, in event of no preferable plan 
being found feasible. 



17 

3. That the Women's, or Cosmopolitan, Hospital sink its individuality 
in the said General Hospital. The present incomplete building of the afore- 
said Cosmopolitan Hospital might be taken over and equipped for the 
General Hospital on such terms as were mutually agreed upon by the 
Insular Government and the Directors of the Cosmopolitan Hospital, pro- 
vided that the said buildings were pronounced, after examination by experts, 
to be suitable for the purpose. (See appended Report.) 

4. That temporary provision be made for general hospital work until 
such time as permanent quarters are completed. 

5. That the said General Hospital be free to all without prejudice on 
account of race, color, or religion. 

6. That, while the main purpose of the hospital be to minister to the 
poor, ample provision be made for private patients, who will contribute 
special fees determined by the Board of Trustees and used as they may 
direct. 

7. That there be: (a) An out patient department with a public dispen- 
sary, (b) A training school for nurses. 

8. That, mutatis mutandis, the Acts and Ordinances of the Boston City 
Hospital be the basis of the foundation to be known as the General Hospital 
in the city of Manila * * *. 

The following extract from the Secretary of the Interior's 
address upon the -occasion of the laying of the cornerstone of the 
hospital, February 28, 1908, gives a portion of the subsequent 
history very accurately. The first paragraph refers to the peti- 
tion given above : 

The Commission was impressed with the reasonableness of most of these 
requests and with soundness of the arguments brought forward in their 
support. On June 1, 1903, it appointed a temporary committee, consisting 
of Governor Taft and Commissioners Worcester, Wright, and Smith, to 
confer with the Right Reverend Charles H. Brent, the chairman of the 
citizens' committee, upon the question of a general hospital at Manila. 
This conference having been held, the committee of the Commission recom- 
mended to that body the appointment of another committee, consisting of 
the Secretary of the Interior, the Secretary of Public Instruction, the Gen- 
eral Superintendent of Education, and the Superintendent of Government 
Laboratories, to have general charge of negotiations relative to the proposed 
hospital and to meet in joint session with the citizens' committee as occasion 
might require. It was instructed to investigate and report as to whether 
it would be wiser to utilize the Exposition Grounds, where the building of 
the Bureau of Government Laboratories had already been erected, as a site 
for a hospital and a medical school, reserving the land which Commissioner 
Legarda had offered to donate as a site for secondary schools, a normal 
school, and all departments of the future university except the medical 
school and possibly the law school; or to accept Commissioner Legarda's 
proposition to use the property offered by him for the hospital and to con- 
tinue the use of the Exposition Grounds for educational purposes. The 
committee was further directed to report on the practicability of erecting 
a temporary hospital and also on the possibility of securing from the Army 
the Third Reserve Hospital until new buildings could be constructed. 

A word of explanation as to the question thus raised relative to the 
hospital site. The Bureau of Government Laboratories had long since 
outgrown its temporary quarters back of the Civil Hospital. As its work 

107997 2 



18 

had increased the necessity for the construction of a modern laboratory 
building had become manifest, and when a site for this building was 
sought Commissioner Legarda had generously offered to donate a large 
lot, beautifully situated on an extension of the Santa Mesa ridge, but 
for more than a year unexpected legal complications had prevented his 
conveying this land to the Government. Meanwhile the necessity for the 
erection of the new laboratory building had become so urgent that the 
Secretary of the Interior, after considering all other available locations, had 
requested the Commission to set aside a site for it on the Exposition 
Grounds, at the same time calling attention to the fact that the erection of 
a laboratory building there would logically involve the construction of hos- 
pital and medical school buildings on the same tract of land. 

The Exposition Grounds had originally been provisionally set aside for 
educational purposes, but, with the approval of Professor Bernard Moses, 
the Secretary of Public Instruction, the policy of placing the new laboratory 
building there was agreed to, as were the logical consequences of this policy. 
Meanwhile some of the buildings already on the ground had been occupied 
by teachers, and at a later time the establishment of the Normal School 
in others had been approved by the Secretary of the Interior, with the 
distinct understanding that such occupation of these buildings was to be 
temporary and to continue only until they were required for hospital 
purposes. 

Several meetings of the joint committee were held, and in the end it was 
agreed to recommend to the Commission the utilization of the Exposition 
Grounds as a site for the General Hospital and the immediate establishment 
of a temporary hospital in the buildings then occupied by the Norinal 
School and by teachers, it having been first ascertained that the Third 
Reserve Hospital building could not be secured from the military authorities. 
The Commission adopted the recommendation of the joint committee relative 
to site; but as there were no suitable quarters to which the Normal School 
could be immediately transferred, and as its work was too important to be 
even temporarily interrupted, decided not to attempt the establishment of 
a temporary hospital on the Exposition Grounds, but pending the erection 
of new buildings, to utilize to the fullest possible extent, and to increase if 
necessary and practicable; the facilities of the Civil Hospital. 

The Chief of the Bureau of Construction and Public Works was instructed 
to proceed immediately with the preparation of plans for a pavilion hospital 
of 300 beds. The joint committee continued its labors, appointing technical 
subcommittees on law and on hospital plans. Ultimately it recommended 
to the Commission for adoption the draft of an act for the establishment of 
the Philippine General Hospital. The preliminary hospital plans prepared 
by Architect Bourne were returned to him after being made the subject of 
painstaking criticism, and on March 25, 1904, final plans, acceptable in 
form to the joint committee, were adopted. Shortly afterward they were 
forwarded to the Commission, with the recommendation that constructiofi 
work be inaugurated at an early date. 

And now this long-cherished and long-delayed project met with a serious 
reverse which, for the time being, threatened to be fatal. The Insular Gov- 
ernment had fallen upon evil days. In its eagerness for progress it had 
expended very large sums for the establishment of a system of public instruc- 
tion, the construction of public works, the maintenance of public order, the 
preservation of public health, and for other important public purposes. Its 
revenues had fallen far short of expectations and were steadily decreasing. 



19 

The bare bottom of the Insular Treasury was looming ominously before the 
eyes of the legislative body, and unfortunately the carefully prepared plans 
submitted by Architect Bourne, and approved by the joint committee, called 
for the expenditure of a sum greatly in excess of that which could safely 
be made available. 

An additional complication now arose as the result of suggestions from 
the Commanding General relative to the transfer to the Civil Government 
of a number of buildings occupied by the Army, including its Ji'irst Reserve 
Hospital. The Secretary of the Interior and the Director of Health were 
reluctantly forced to admit that, although the First Reserve Hospital site 
was by no means an ideal one and its buildings left much to be desired, 
still in view of the condition of the Insular Treasury, if they could be 
obtained it was the part of wisdom to accept and to utilize them. Nego- 
tiations for securing them were inaugurated and pushed forward as rapidly 
as possible, but they dragged on for a long period and finally, during the 
visit to the Philipines of the Secretary of War and the Congressional 
delegation, the conclusion was reached that they could not be transferred. 
Meanwhile the joint hospital committee after some fruitless attempts to 
secure aid in the United States, had lapsed into a permanent state of sus- 
pended animation. 

But help had come from an unexpected quarter. On April 1, 1905, a 
committee had been appointed by the Governor-General for the purpose of 
inquiring into and thoroughly analyzing the organization of Bureaus and 
Offices of the Insular Government with a view to determining the useful- 
ness of each Bureau or Offiice, the possibilities of improvement therein by 
eliminating the duplication of labor, and the further purpose of considering 
the equalization of salaries, the methods employed in bookkeeping, and 
generally to suggest any changes in office management that would tend to 
simplify methods of labor and be productive of economy and increased 
efficiency. This committee was quick to see that in operating a hospital 
in a scattered group of unsuitable rented buildings, located on an insanitary 
site, the Insular Government was pursuing a poor business policy and that 
the money usually paid out in rental represented the interest on a large 
sum which might well be invested in suitable buildings, thus making pos- 
sible a more economical and efficient administration. The committee in its 
report strongly recommended that such buildings be constructed. Mean- 
while the condition of the Insular finances had steadily and quite rapidly 
improved, and an authorization by the Congress of the United States for 
the issue of bonds to the extent of $5,000,000 to secure funds for the con- 
struction of public improvements had further relieved the situation. The 
Secretary of the Interior filed a vigorous claim against the first bond issue 
for a sum sufficient to erect suitable general hospital buildings and, aided 
by the Director of Health, undertook to secure the preparation of new plans, 
the carrying out of which would result in furnishing the needed facilities 
without imposing on the Insular Treasury so heavy a burden as would have 
been involved in erecting the building planned by Architect Bourne. This 
course was resorted to reluctantly, for the reason that it entailed further 
delay, but no other seemed possible. 

On April 15, 1905, Dr, Victor G. Heiser assumed the duties of 
Commissioner of Public Health which office had been left vacant 
by the resignation of Major E. C. Carter. Dr. Heiser, first as 
Commissioner of Health and after November 1, 1905, as Director 



20 

of Health, gave material and active assistance in helping perfect 
plans and later, when the project became a reality, in noting 
and correctmg defects in the work. After the report of the 
reorganization committee had been received he, on October 4, 
1906, sent an urgent communication to the Secretary of the 
Interior in which he makes a very concise statement of the neces- 
sity for the hospital in the following language : 

Within a short time the Civil Hospital problem will necessarily come be- 
fore the Commission for solution, therefore, I take this occasion to call 
your attention to certain facts and. recommendations pertinent thereto, for 
the purpose of setting forth the requirements of the situation. 

The reorganization committee, after an exhaustive examination into the 
conditions under which the institution is now conducted, reported that: 

"The present Philippine Civil Hospital buildings and site are so expensive 
and unsatisfactory, that your committee respectfully urges the immediate 
construction of the nucleus of a general hospital as a measure of economy 
as well as an essential to eiflciency. The present rental charge is ?12,000 
per annum, which, at the rate of the last bond issue, would be the interest 
on approximately $400,000.00. The number of employees now required, by 
reason of the poor arrangement of wards, would be able to care for a 
larger number of patients in a properly arranged establishment. The 
land immediately adjoining the grounds of the present hospital is so low 
and in such an insanitary condition, that, according to a recent survey, 
about ?50,000 would be required to make the location even tolerable. It is 
reported that inmates of the hospital have contracted diseases traceable 
to the conditions just described." 

The report, while brief, is so comprehensive and accurate that little 
remains to be said except to set forth a few reasons why a modern hospital 
is so urgently needed, and this I shall do in numerical sequence for the 
sake of brevity, without regard to orderly arrangement as determined by 
their relative importance: 

1. The contract which the Government enters into with its employees 
provides that they shall be entitled to medical care and treatment. It is 
impossible properly to meet this obligation under the present conditions. 

2. In order that the medical officers charged with the responsibility of 
caring for the health of the officers and employees of the Civil Government 
may do themselves justice and render that degree of service rightfully 
expected by the patients themselves, better facilities are required. 

3. In view of the fact that the Commission has to some extent committed 
itself to the policy recommended by not making appropriations for the 
repairs that will have to be made on the present buildings, if they continue 
to be occupied for hospital purposes, prompt action will be necessary. 

4. One of the most difficult features, especially in the Philippines, in 
the successful administration of a hospital, is the question of keeping an 
adequate force of competent nurses. It is proposed to remedy this con- 
dition by training native women as nurses, and through them, not only 
overcome the difficulty as presented throughout all parts of the Philippines, 
but also to eliminate the cirujano ministrante with his uncertain status, 
and the mediquillo with his total ignorance of the science of medicine. 

5. The death rate of the city of Manila is still abnormally high, and 
improvements are hardly to be looked for until there are proper facilities 
for studying in hospitals the diseases which are responsible for the high 



21 

rate of mortality. During the month of July there were 743 more deaths 
in Manila than during the corresponding period of last year. A large 
jpercentage of these deaths were ascribed to such indefinite causes as 
bronchitis, meningitis, and similar diagnoses, which fact shows the imper- 
ative need of better facilities for the application of scientific knowledge 
and exact methods of diagnosis in the treatment of disease. 

6. The time has come when modern facilities are needed by the hospitals 
of the city for the teaching of clinical medicine to physicians and medical 
students in order that a new era of practice based on accurate diagnosis 
.may supplant the present system of haphazard drug prescribing. 

7. Through such a hospital as is contemplated, ample facilities without 
additional cost would be available for imparting instruction to midwives 
-and medical students in the science and art of obstetrics, and through this 
knowledge, to redeem from the present fatal ignorance and superstition, 
and save many a life which under the present practice would be sacrificed 
-and accounted for as a consequence of the prevailing excessive infant 
jnortality. 

8. A modern hospital would be a powerful factor in disseminating 
sanitary and hygienic knowledge among people. To similar agencies Japan 
is indebted for her wonderful health service. 

9. The location and structural defects of the buildings now occupied as 
-a Civil Hospital, preclude the practicability of remodeling them for a new 
hospital, even if the land were the property of the Government, hence the 
-advisability of selecting a location which will meet all the requirements, 
for instance, such as the grounds near the Bureau of Science, an institution 
■on which much of the scientific work of the hospital will largely depend. 
Inasmuch as this site is satisfactory with reference to its location and 
environments, it is recommended that it be immediately approved and set 
apart for hospital purposes. 

10. The present Civil Hospital does not offer that privacy for maternity 
-cases to which they are justly entitled. 

The plans and estimates of the Consulting Architect to the Commission, 
are forwarded herewith. While the undersigned is not prepared to indorse 
every detail in the plans, yet, on the whole, it is believed they are satis- 
rfactory and that such changes as are recommended will not increase the 
■estimate beyond half a million pesos. 

With a new modern building and increased facilities for taking care of 
native patients, the work of the hospital could be made a mighty factor 
in demonstrating the sincerity and helpful purposes of the American Gov- 
ernment. Foreign mission boards of all denominations rely on their 
hospital and medical services to gain the confidence of the people whom 
they desire to influence. One satisfied, grateful patient is worth more 
than a thousand nominal adherents, as he remains a friend for all time 
to come. 

Commissioner Worcester forcibly expressed his views on the 
subject, in a letter to the Governor-General on October 21, 1906, 
in the following language which is a partial reproduction of the 
communication : 

Finally, I desire urgently to recommend to the Commission the early 
-construction upon the Exposition Grounds of a sufficient number of build- 
ings of a pavilion hospital to furnish approximately 200 beds, this hospital 
to be constructed in accordance with the plans prepared by the Consulting 



22 

Architect which allow of systematic future development through the ad- 
dition of other ward buildings which have been planned for at this time 
and for which adequate ground space should be reserved in accordance 
with the plan now presented. 

The question of the establishment by the Insular Government of a 
general hospital at Manila is a rather sore subject with me. The utter 
inadequacy of the buildings at present used, the insanitary nature of the 
site on which they stand, and the very excessive cost to the Insular Gov- 
ernment of maintaining this hospital as it is at present conducted, are hard 
facts which have been repeatedly brought to the attention of the Commission 
and have also been frequently made the subject of by no means unjustified 
attacks in the public press. The recommendations of the Reorganization 
Committee on this subject are brief and to the point and their soundness 
can not, I think, be gainsaid. I long since brought to the attention of the 
Commission the urgent necessity for beginning the work of the construc- 
tion of a general hospital on a site which would allow of adequate future 
development, and served formal notice that as soon as I could secure 
accurate statements as to what was necessary at the outset and what it 
would cost, I would request an appropriation from the bond issue of an 
adequate sum to begin this work, and protested against the inauguration 
of any policy which would, so to speak, mortgage the bond issue to such 
an extent as to render impossible hospital construction to be paid for from 
funds obtained in this manner. 

I understand that it was formally agreed that a reasonable expenditure 
from the bond issue for this purpose should be made. Fortunately, how- 
ever, the improvement in the financial condition of the Insular Government 
makes possible the expenditure during the present year of a considerable 
sum from general revenues for public improvements. It is immaterial to 
me whether the necessary amount is appropriated from the bond issue or 
from other Insular funds, but I strongly urge upon the Commission that 
at this time it put an end to the present unsatisfactory conditions and 
make adequate provision for an institution which shall be a credit to the 
Insular Government. * * * 

In closing, I beg to suggest that the only considerable expenditure ever 
made by any of the Bureaus of the Department of the Interior for puWic 
improvement has been the comparatively small one involved in the con- 
struction of the new building of the Bureau of Science, while very large 
sums have been expended for public improvements by other Departments 
of the Insular Government. I feel that it is no more than just that this 
great need of the Department, which is at the same time a public need, 
should now be met. 

I have myself been repeatedly publicly charged with delaying the work 
of hospital construction. The members of the Commission, at least, are 
well aware that I have favored only such delay as would allow the secur- 
ing of a proper site and of adequate plans. Inasmuch as the amount 
expended must necessarily be large, I have determined that the necessary 
steps should be taken to secure wise expenditure before I would make 
recommendation to the Commission. The hospital plans originally prepared 
by the former Chief of. the Bureau of Architecture and Construction of 
Public Buildings involved what was, in my opinion, an extravagant expendi- 
ture and I was therefore not prepared to recommend their adoption. The 
plans prepared by the Consulting Architect seem to be the best that we 
can secure and I think that they should be adopted. 



23 

It is probably needless for me to say anything in regard to the site for 
these buildings as this has been fixed long since by the Commission and so 
far as I know there is no purpose at this time to reverse the action then 
taken. There is, however, every reason why the buildings should be put 
on the Exposition Grounds. This site is cool and can readily be made 
sanitary. It is well removed from noise and dust and there is sufficient 
ground 'to allow for all probable future development. Proximity of the 
building of the Bureau of Science will be a very great convenience and 
will save some little expense. 

I am more than ever convinced that this piece of ground should be 
reserved for the scientific work of the Insular Government. 

Quoting further from the address of the Secretary of the In- 
terior upon the occasion of the laying of the cornerstone we find 
the later history of the formative period of the hospital related as 
follows : 

As rapidly as possible Mr. W. E. Parsons, the Consulting Architect to 
the Commission, prepared preliminary plans and estimates, and prior to 
the departure of the Secretary of the Interior for the United States in 
October 1906, they were transmitted to the Commission with an urgent 
request from that official and from the Director of Health that the necessary 
funds for carrying them out be immediately appropriated and the construc- 
tion work inaugurated as soon as possible. 

Other counsels prevailed, however, and the whole project was laid on 
the table where it was found peacefully reposing by the Secretary of the 
Interior on his return in April, 1907. 

Before making final recommendation to the Commission, he deemed it 
fitting and desirable to secure the opinion of the faculty of the newly 
established Philippine Medical School as to the necessity for a Government 
general hospital. The faculty immediately approved the project but ob- 
jected to the small number of beds planned for at the ouset, insisting that 
300 should be provided for instead of 200 proposed. The arguments which 
they brought forward in favor of this course seemed unanswerable, and 
the Director of Health and the Secretary of the Interior united in request- 
ing the Commission to appropriate the sum of ?'780,000 in order to make 
possible the erection of a central administration building, a surgical 
pavilion with two operating rooms, a building for dispensary and outclinic, 
five ward pavilions of sixty beds each, a nurses' home, a kitchen, an 
ambulance stable, and morgue. By unanimous vote of the Philippine Com- 
mission the full sum requested was appropriated. 

It was with a profound sense of gratification that those who 
had labored so long and earnestly for the completion of the project 
finally saw a chance for the realization of their hopes. With 
the necessary funds available the greatest obstacle had been swept 
away, although the real, active, hard work remained to be done 
as there were a multitude of details to be thought out and unfore- 
seen complications arose continually. 

A meeting of the Philippine Islands Medical Society was to be 
held in Manila early in 1908 and this was deemed an opportune 
occasion of the laying of the cornerstone of the new hospital. 



24 

Accordingly, although no contracts had been let nor had the 
exact locations of the different structures been determined, the 
cornerstone was laid February 28, 1908. 

Dr. Fernando Calderon, a leading Filipino physician of Manila, 
during an address upon this occasion made the following state- 
ments, several of which strike to the core of the subject : 

The construction of the edifice whose cornerstone is laid today in this 
beautiful field endowed with unsurpassable hygienic conditions is an event 
which ought to be greeted with rejoicing by all the Filipino people. 

It signifies in the political order that the Insular -Government, abandon- 
ing the individualistic theory of laissez faire, is convinced that its sphere 
of action is not limited merely to administering justice and maintaining 
the liberty of the inhabitants of this archipelago, but that it must, in ad- 
dition, watch over those neglected by fortune, the weak ones of society, 
supplying their most pressing necessities. 

Among those necessities it is indubitable that the preservation of the 
life and the health of the citizens occupies first place; wherefore, the 
Government, inspired by the modem ideas of democratic and cooperative 
governments, and complying with a duty not merely moral and altruistic 
but juridicio-social, decided to build a public hospital sustained from 
public revenue for the benefit of the 7,000,000 inhabitants who people these 
Islands in general, and those neglected by fortune in particular. 

The hospital will be named the Philippine General Hospital, because it 
will be destined principally for the use of the Filipino people. It will 
inaugurate its work with 350 beds, and will consist of several pavilions 
constructed in modern styles to avoid massing the patients. 

It VTill have the following departments: 

1. Administrative. 

2. Surgical operating rooms. 

3. Kitchen. 

4. Dispensary. 

5. Nurses' home. 

6. Pavilion No. 1 (private rooms). 

7. Pavilion No. 2 (surgical cases). 

8. Pavilion No. 3 (medicine). 

9. Pavilion No. 4 (children, medicine or orthopedics). 
10. Pavilion No. 5 (obstetrics). 

The first five departments, that is, those destined for administration, 
operating rooms, kitchen, dispensary, and the nurses' home, will be built 
of such size that they can serve permanently as the fundamental basis of 
the future hospital, even though it should become necessary in the future 
to construct a larger number of pavilions. 

The pavilion of medicine will open its doors to the sick who belong to 
the group of medical pathology, and especially to those who are suffering 
from tropical diseases, from local causes of climatology, physiology, habits, 
customs, and alimentation. Difficult medico-social problems for the physical 
regeneration of the Filipino race will be solved in this pavilion of medicine. 

The pavilion of surgery will be open to persons suffering from surgical 
affections, and in case operations are performed upon them, they will not 
be mixed with the patients in general medicine, there being thus constituted 
a certain guarantee against all infectious contamination. 

And what shall I say of a pavilion destined for the sick children of 



25 

Manila where these tender beings die annually by thousands, the total of 
infant mortality ascending to a number capable of horrifying the most 
temperate mind? I shall say only two words: That it is a long-felt social 
necessity in order to be able to undertake clinical infantile diseases of 
Philippine type, as yet unknown to science. 

Neither shall I dwell on the highly important services which, in its day, 
the future pavilion of obstetricts or clinic of parturition which is to be 
•erected, will render to the women and children of our country, because all 
will comprehend the necessity for an ample, hygienic and comfortable place 
to which those unfortunate women can go to give birth, who now perform 
that transcendental act of life in miserable, insanitary huts, completely 
^ven over to charlatanism and the ignorance of the illegal practitioners 
"who officiate as midwives, with great danger to them and their new-born 
habes. 

A general hospital with 300 beds for a city like Manila with 220,000 
inhabitants, in addition to the sick coming from the provinces is not, we 
may say, a very spacious hospital for completely filling the requirements 
of so numerous a population. 

The systematic opponents of the projects, those traditional reactionaries 
of the first class who find nothing good except conversation and routine, 
will say, perhaps, that since some hospitals already exist in Manila why 
burden with this new weight the budget of the country which is now under- 
going an economic crisis; but let such professional critics remember that 
what constitutes the nerve of human civilization in the present epoch is 
precisely public hygiene in the towns in general and the health of each 
citizen in particular, for which purposes modern governments do not spare 
tixpense to place them on the highest plane. 

True, there are in Manila some hospitals of antiquated styles, in truth, 
such as San Juan de Dios, St. Paul's, the Civil Hospital, the University Hos- 
pital, and Bethany, which are far from answering the present needs of this 
•city. I do not mention the sick-ward of Bilibid nor Hospital "B" of Bilibid 
Prison, nor the military hospitals located here, because they are for the ex- 
clusive use of prisoners and the Army. The San Lazaro pavilions do not 
•constitute a hospital but only isolation houses for cases of cholera, bubonic 
plague, and smallpox. 

The hospital of San Juan de Dios, to which the Filipino people owe 
immense gratitude, as it has really been the only beneficent establishment, 
vyhich, from its own funds, and within its limited means has been admitting 
poor sick, at present maintains about 100 beds for the needy, apart from the 
60 paid for by the city government. 

St. Paul's Hospital has funds at its disposal to support only fourteen 
beds destined for poor children, as the other 100 beds for indigents which 
are. there at present are paid for, 50 by the city and 50 by the Philippine 
Medical School. 

The Civil Hospital does not support any, except a few for emergency 
cases, the University Hospital fifteen beds and Bethany Hospital, improp- 
erly so called because it is nothing more than a dispensary, supports six 
beds for children and poor women. 

Not counting, then, those 150 official beds which the Government will 
take over by erecting its own hospital and putting its poor sick under better 
^hospital conditions, how many beds for the poor sick would there then be 
available for the entire city of Manila? The insignificant number of 135 
beds. 



26 

Thus this new edifice, capable of receiving 350 sick, a very small part 
of whom will be paying patients, comes to fill an immense void in the capital 
of the Archipelago. 

It is plain that even with such a number of beds we shall still not have 
reached the desideratum of the aspirations directed towards sending to a 
hospital and caring for all the poor sick of the city of Manila and the 
surrounding provinces who may request aid. A hospital with capacity for 
a thousand patients would be necessary for this. 

If, in this same manner that the American Congress every year votes the 
money necessary for the construction of four battleships, the Insular Gov- 
ernment, imitating this example and adopting a definite program, were to 
grant, if only two years, money sufficient for the erection of a new pavilion 
destined for this general hospital, at the end of a few years we should see 
the realization of the beautiful ideal of being able to send to a hospital the 
poor sick who swarm Manila and the adjacent provinces. 

The cornerstone was laid by the Secretary of the Interior, the 
Honorable Dean C. Worcester. A portion of his address delivered 
at this time is quoted below : 

Our distinguished guest. Sir Allen Perry, in his eloquent and most in- 
teresting address, has brought forcibly to your attention the vital im- 
portance of adequate hospital facilities in the tropics, even suggesting as 
a criterion of civilization of a country, the number of its hospitals and the 
character of their equipment. His position entitles him to speak with 
authority on this subject, for perhaps in no other tropical country has 
hospital work reached so advanced a stage of development as in Ceylon. 

Professor Calderon has clearly demonstrated the great need of govern- 
ment general hospital at Manila and has made plain the substantial benefits 
which will accrue from it to the people of that city and of the Philippine 
Archipelago. 

If the statements of these gentlemen are true, and we know that they 
are true, the question naturally suggests itself, why has the Insular Gov- 
ernment . so long delayed the establishment of an institution which is 
destined to be so useful and which has been so imperatively needed? 

It has fallen to my lot to give a brief review of the facts. Had I been 
requested to justify, in all particulars, the policy which has been pursued, 
I should have declined the honor. Speaking candidly, I am of the opinion 
that the establishment of a general hospital has been unduly delayed. 
Nevertheless, it is true that grave obstacles have been encountered, and 
the facts when stated will extenuate, even if they do not fully excuse, the 
course which has been pursued. 

The present hospital situation in these Islands, so far at least as con- 
cerns Government institutions, is most abnormal. The Insular Government 
made provision for sufferers from bubonic plague, smallpox, cholera, 
leprosy, and other dangerous communicable diseases by the establishment 
of the San Lazaro Hospitals and the Culion lieper Colony. It has erected 
a fine hospital for the proper care of the insane. It has established 
admirably equipped quarantine stations at Manila, Cebu, and Iloilo. Yet, 
while very heavy expense has thus been incurred in caring for the insane, 
in providing hospital facilities for the comparatively limited number of 
sufferers from dangerous communicable diseases, and in preventing the 
introduction and checking the spread of such diseases, little has been done 
to relieve the afflictions of that larger portion of the population suffering 



27 

from ills which are not readily communicable to others and may be mini- 
mized, or completely relieved, by medical or surgical intervention. 

We have, to be sure, free dispensaries in the city of Manila. We have 
also our Civil Hospital; but the latter institution is established in a group 
of three buildings which were intended for private residences and are not 
really suitable for hospital purposes. The largest of them has in its im- 
mediate vicinity marshy, mosquito breeding lands which can neither be 
drained nor filled at reasonable expense, and which necessarily render the 
site highly objectionable. Furthermore, the space available in this insti- 
tution is to so large an extent required for Government officers and em- 
ployees that at best comparatively few beds are available for the general 
public. 

In order to make some provision for the needy poor of Manila and to 
secure necessary clinical facilities for the students of the Philippine 
Medical School, we have been forced to hire beds in private hospitals, and 
it is indeed fortunate that we have been able to do so. 

At last this extraordinary condition of aifairs is to be terminated. How 
is it that it has been allowed to continue so long? 

Professor Calderon has just advanced the claim that the Philippine 
Medical School should be considered the mother of the Philippine General 
Hospital because of the adoption of the recommendation of its faculty that 
the number of bqds to be established at the outset be increased to 300. He 
has assigned the relationship of grandmother to the Bureau of Science and 
that of great grandfather to myself. 

May I be permitted to suggest that he has left a serious gap in the 
parentage of this lusty infant and to nominate for the important position of 
father the Director of Health, Dr. Victor G. Heiser. I regard the desire 
of the Medical School to establish relationship as a distinct compliment to 
the child. I have noticed that in the case of the public improvements in 
the Province of Benguet there was at one time a distinct willingness to 
accord to one man the honor of being the whole family of that infant, but 
later when the great highway to our summer capital had been completed 
and people had begun to realize what we had obtained for our money, there 
was no longer a lack of would be near relatives. Even an orphan can usually 
find foster parents if he becomes sufficiently promising as he develops. 
Far be it from me to try to keep the Philippine Medical School out of the 
General Hospital family, but a due regard for the verities of history 
compels me to call attention to the fact that a comparison of the date of 
conception of the General Hospital project with that of the date of the 
birth of the Philippine Medical School forever debars the latter institution 
from any claim of motherhood. To the Philippine Commission, which ap- 
propriated the necessary funds, should, I think, be assigned maternal honors 
in this case, but the valuable assistance rendered by the Philippine Medical 
School in moulding public opinion and in demanding a suitable increase in 
the number of beds certainly entitles it to rank as nurse. 

We have met to-day to lay the cornerstone of the Philippine General 
Hospital. Although the delay in providing for this institution has been 
long and at times disheartening, we may well feel that it has in large 
measure been compensated for by the liberality of the provision which has 
now been made. The hospital has been planned on broad lines. With the 
very adequate facilities which it will have at the outset for administrative 
officers and for operative surgical work, its capacity can be almost inde- 
finitely increased by the construction of additional ward pavilions. The 



28 

Exposition Grounds are amply large to admit such expansion and must be 
kept available for hospital purposes. 

When the Philippine General Hospital, the Philippine Medical School 
and the Bureau of Science buildings stand, as they soon will stand, side by 
side, with the Bureau of Science working, as they have always worked and 
must always continue to work, hand in hand, this Government may, I think, 
feel that it is not only fulfilling its duty in safeguarding the health of the 
inhabitants of these Islands, but that it is contributing its full share toward 
the solution of the many grave problems involved in combating tropical 
■diseases, and in making tropical countries not only habitable but healthful 
for men of every race. Who shall measure the future usefulness of the 
institution which we are about to found in alleviating human misery, in 
prolonging useful lives, and in training the men and women of this country 
^s nurses, as physicians, and as surgeons? I count it both a great privilege ; 
and a high honor to lay its cornerstone. ''i 

The herculean task of perfecting plans and specifications for 
the different structures, in order to have them adapted to their 
purpose and at the same time be covered by the appropriation 
and the deciding of many other details consumed considerable 
time so that bids were not advertised for until June 24, 1908. 
When the bids were opened on July 27, it was found that the 
lowest bid had been made by H. Thurber, of the Manila Con- 
struction Company. He was accordingly awarded the contract, 
for the erection of the administration, medical, surgical, mater- 
nity, private, orthopedic, and operating pavilions and. the kit- 
chen, on September 8, 1908 for the sum of tP530,804. His 
contract specified that these structures be of reinforced concrete 
and that they be completed within 240 working days. The 
plumbing, wiring, filling, and a few other minor details were not 
included in this bid. 

Such in brief, is the early history of the institution and we now 
<2ome to the more interesting stage of results obtained by nine 
years of striving. 

DESCRIPTIVE. 

Actual construction work was begun shortly after the awarding 
of the contract but the usual number of vexatious delays occurred, 
conferences were held and changes in plans made until it became 
evident that the buildings would not be completed within the 
specified time. The contractor asked for and received two exten- 
sions on the time contracted for, the sum of which extended the 
date for the completion of the structural work to November 30, 
1909. 

After the structures were erected the process of finishing the 
interior and obtaining and installing equipment necessitated sev- 
eral months so that the opening of the institution was deferred 
to a much later date than was originally intended. 



29 

The question of supervision of the hospital had been definiteljr 
settled by the passage of Act 1989, which took effect July 1, 1910. 
The portion of the Act covering this question reads as follows : 

The Philippine General Hospital is hereby declared to be a division of 
the Bureau of Health, * * * and the Director of Health shall cause 
to be furnished in the Philippine General Hospital care of Government 
patients as now required of him by Act Numbered Fourteen hundred and 
seven. Rules governing the admission of patients to the Philippine General 
Hospital, charges for hospital service and hospital administration shall be 
made by the Director of Health, subject to the approval of the Secretary 
of the Interior. Provided: That the selection of patients for admission to 
free beds set aside for the use of the Philippine Medical School shall be 
subject to such rules as the Board of Control of the Philippine Medical 
School may prescribe: and provided further: That the Director of Health, 
subject to the approval of the proper head of department or of the Board 
of Control of the Philippine Medical School, as the case may be, may require 
the services, without additional compensation, of any medical officer or 
employee in the Government Service. (Act No. 1989.) 

The "General Statement" of the Secretary of the Interior writ- 
ten for the hospital rules and regulations contains some very per- 
tinent facts as evidenced by the following extracts therefrom : 

The Philippine General Hospital opened its doors to the public on Sep- 
tember 1, 1910. This event marked the successful termination of efforts 
which had extended over many years. At the outset it was necessary to 
create in Manila a proper interest in the establishment of a large modern 
Government hospital. When this had been done, plans and estimates were 
necessary as a basis for a request for an appropriation. It was by no 
means easy to secure plans for a series of hospital buildings which would 
admit a maximum of light and air and at the same time should not become 
excessively hot during the middle of the day; nor was it easy always to 
harmonize the technical requirements deemed essential by the Director 
of Health and the Secretary of the Interior with the artistic features ad- 
vocated by the Consulting Architect. A long time necessarily passed before 
final plans were agreed upon, but it is believed that it was time well spent. 

Immediately adjacent to its grounds are the buildings of the Bureau of 
Science with excellent laboratory facilities, and the building of the Phil- 
ippine Medical School. This gives an ideal arrangement. Laboratory 
work for the hospital is performed by the staff of the Bureau of Science. 
Access to the hospital and to the library and laboratories of the Bureau of 
Science is easy for medical students, and the hospital profits by the services 
of physicians and surgeons who are employees of the Bureau of Science and 
of the Philippine Medical School. 

Under this arrangement, which makes possible the utilization of the best 
men in the service in connection with hospital work for which they have 
demonstrated special aptitude, it has been possible to organize a staff of 
very exceptional ability. It should not be supposed, however, that patients 
of the hospital have any limitation imposed on their choice of physician or 
surgeon. The institution is open to every reputable practitioner and every 
patient has the right to call the physician or surgeon of his choice. 

The Philippine General Hospital will fulfill four distinct needs. 



30 

It will offer to the general public exceptionally good facilities for the 
healing of injuries and the curing of diseases. 

It will assure to officers and employees of the Government, who are 
entitled to have medical or surgical care free of charge, a quality of attend- 
ance seldom equaled and it is believed never excelled under similar conditions. 

It will offer to medical students exceptional facilities for practical in- 
struction. For the outset there will be one hundred free beds which will 
be used for purposes of instruction in connection with the Philippine Me- 
dical School, and the teaching clinic of the institution will be open to any 
properly accredited student of medicine and surgery. 

Thus the hospital will from the outset not only meet the needs of Gov- 
ernment officers and employees and those of many private citizens who 
are able and willing to pay for the accommodations and services which it 
affords, but will be a great public charity as well. 

Finally, it will accomplish another very important work in the training 
of young Filipino men and women as nurses. Many of these nurses will 
go out into the provinces as veritable missionaries of modern medicine, 
surgery, and hygiene with the natural result that thousands of lives will 
be saved among those who to-day have little or no understanding of the 
importance of availing themselves, when injured or ill, of the facilities 
which modern hospitals afford. One of the most important things to be 
done is to arrange a systematic search in the provinces for surgical cases 
which are operably relievable, bring such cases to the hospital where they 
can be dealt with under most favorable conditions and keep them there 
until recovery is well advanced or is complete. 

The future development of the work of the Philippine Medical School, 
the Philippine General Hospital and other divisions of the Bureau of 
Health, and the Biological Laboratory of the Bureau of Science will not 
only relieve an immense amount of avoidable human suffering, but will 
ultimately bring about the hygienic regeneration of the Philippine Islands 
by their own people. Meanwhile we may hope for the carrying out of 
scientific investigation leading to results of very great importance to 
this and other tropical countries. 

As previously stated, the long looked and hoped for day arrived 
and the hospital v^as officially opened on September 1, 1910, and 
a largely attended public reception was held in the hospital in 
honor of the event. On the following day ten patients were 
transferred from the old Civil Hospital to the new structure; 
coincident with this act the former institution passed into oblivion 
after more than nine years of useful, if somewhat turbulent, ex- 
istence. 

The new hospital is situated nearly in the center of a tract 
of land bounded by Calle Padre Faura on the north, Taft Avenue 
on the east, Calle Herran on the south, and the weather observ- 
atory grounds on the west. This tract contains nearly 11 hec- 
tares (27 acres) and is known as "Medical Center" on account 
of the Bureau of Science and the College of Medicine and Surgery 
being located on the same plot. (See block plan) . -It is most 
conveniently located, being well within the city limits and acces- 
sible by two trolley lines. 



31 

A new set of rules and regulations were promulgated and 
inasmuch as it is a Government institution and physicians are 
permitted to treat private office patients in the hospital these 
rules were, of necessity, peculiar to this hospital. Many problems 
have had to be solved and new rulings made; however, in spite 
of all the obstacles encountered, it has gained steadily in popular- 
ity and efficiency due in part to the hard work and persistent 
efforts of the acting superintendent. 

The moral influence of the hospital and object lessons taught 
patients and servants along the line of cleanliness and sanitation 
are bound, ultimately, to make their influence apparent in the 
home lives of the people and this brings to light another field of 
its usefulness. 

The Superintendent in his annual report sums up the objects 
of the hospital as follows : 

The objects to be accomplished by the Philippine General Hospital are 
varied. The patients also fall into a number of classes: 
The following table outlines both objects and classes : 
To care for Government employees 

when sick Beneficiaries. 

To provide hospital service for the 

city's poor and injured City contract patients. 

To provide hospital accommodations 

for the general public Pay patients. 

To provide hospital accommodations 
for such poor and needy as have 
diseases which are useful and in- 
teresting for clinical instruction.. Medical College patients. 
To provide a hospital where re- 
search work and study of disease, 
its cause and cure, may be unre- 
strictedly pursued Scientific cases. 

To provide immediate treatment for 
the injured, or actually ill, with- 
out any other aim than to be of 

help in time of need Charity cases. 

There are four fundamental functions that are paramount in this 
hospital. They are as follows, arranged according to their rank and 
importance : 

The Patients. — Care and treatment of the sick and injured. 
The Disease. — Research and study of disease. 
The Doctor. — Education of physicians. 
The Nurse. — Education of nurses. 

GENERAL AND SPECIAL FEATURES. 

Ambulance service. — Patients are transferred to and from the 
hospital by means of electric ambulances, by means of which the 
transfer is made in the shortest possible time and giving them 
the greatest degree of comfort possible during this time. A 



32 

physician accompanies the ambulance and gives the patient any- 
necessary attention during the trip to the hospital. The new 
garage and waiting shed has been completed and has sufficient 
capacity for the accommodation of 2 ambulances, 4 automobiles,. 
12 calesas and 6 victorias. 

Beds. — The type of bed furnished a patient has much to do 
with his bodily comfort and equanimity of mind. The beds with 
which the hospital is equipped are admirably adapted to give the 
best results along these lines. They are three-quarter size iron, 
white enameled, have good springs and mattresses and are sup- 
plied with five-inch rubber tired wheels, which make it very easy 
to move them from place to place noiselessly and without jarring 
the patient. A number of the adaptable "peritonitis" beds are 
in use and are a very valuable adjunct to the comfort of certain 
classes of patients in that they may be adapted to any position 
or angle in which it may be desired to place a patient. 

Clocks. — Upon entering the vestibule, a large clock is seen to 
the left; this is the master of the system of electric self-wind- 
ing and regulating clocks with which the hospital is equipped. 
They are distributed as follows : 

Administration pavilion 5 

Surgical pavilion 2 

Medical pavilion 2 

Maternity pavilion 2 

Orthopedic pavilion 2 

Private pavilion 2 

Operating pavilion 4 

Kitchen pavilion 1 

Nurses' home 2 

Dispensary 1 

Garage " 1 

The master of the night watchman's checking system is located 
in the main office and substations are found in all parts of the 
hospital. The watchman is required to register at each of these 
stations at stated intervals. 

Electric fans. — The entire hospital is provided with facilities 
for the use of electric fans; while in some instances a charge 
is made for them, it is very moderate, and many a weary sufferer 
is afforded a great deal of comfort by their use. 

Furniture. — The furniture is made of native hard wood, which 
when polished, closely resembles mahogany. The doors and 
other woodwork are also made from this class of wood. 

Grounds.— The hospital grounds are gradually being laid out 
and parked according to the scheme of an expert in this line of 
work, and when completed will be most pleasing to the eye; 



33 

palm trees are being planted and plants and shrubs set out in 
conformity with the general plan. 

Linen and silver. — The table linen bears the coat of arms of 
the Philippine Government and the seal of the Bureau of Health, 
both of which are woven into the cloth. The towels have the 
words "Bureau of Health" woven into them. Sheets and pillow 
cases have the words "Bureau of Health" stamped on them. The 
hospital silver is neatly engraved with the Bureau of Health 
monogram. 

Telephones. — Four trunk lines enter the building from the out- 
side and connect with a local exchange in charge of a Filipina 
operator; twenty-nine telephones located in private rooms and 
various other parts of the hospital give a very satisfactory service 
as one may talk over the city lines from any one of these house 
telephones. 

The operator also has charge of the system of call bells for 
summoning the resident physicians and superintendent ; each per- 
son has a certain number of rings assigned him as his call, and 
when in use the call rings simultaneously in all parts of the 
hospital ; this system solves what would otherwise be a most an- 
noying and difficult problem in an institution of this size. 

Ventilation. — Even the most critical can find no fault with 
the ventilating scheme of the hospital as practically the whole 
sides of the pavilion may be thrown open by means of the 
sliding doors with which they are supplied ; these doors open on 
a veranda, where many patients are made comfortable during the 
day. It was originally intended to screen the whole institution 
but this idea was later abandoned and nets were placed on the 
beds to exclude mosquitoes, fiies, and other insects. 

Water closets. — A number of the Capoco plate vitreous china 
closets with "Sanitoure Pyralin" seats have been installed in the 
hospital. They, apparently, are the last word in this line of 
equipment from a sanitary standpoint. 

ADMINISTRATION PAVILION. 

Upon entering the hospital by the main entrance one is at once 
favorably impressed by the magnitude and pleasing appearance 
of the vestibule which extends to the full height of the building. 
On either side are seen attractive iron gratings separating the 
record room from the vestibule on one side, and from the main 
oflJce on the other. The floor is laid with large, square, black 
alternating with white vitrified tiling. A telephone has been 
placed here for the accommodation of the public. A touch of 
decoration is supplied by the presence of a number of potted 

107997 3 



34 

plants. In the main office to the right are located desks for the 
use of the superintendent, chief clerk, chief nurse, supervising 
nurse, and their stenographers. Two stenographers are em- 
ployed here for the sole purpose of writing up records. This is 
one of the busiest parts of the hospital as practically all the 
business and financial details are attended to here and in an 
institution of this size this necessarily involves a vast amount of 
work. 

A large fireproof vault is built into the wall of this office in 
which are kept valuable records, and silver which is not in use. 
Upon request, patients' valuables are stored here free of charge. 

The office is light, airy and sufficiently large to avoid crowding; 
at night it is amply lighted by electricity. Corrugated iron doors 
are in use though solid wooden doors are also provided. 

Adjoining the office is the supply room where supplies are 
distributed to the wards, upon requisition, at stated intervals. 
The next two rooms are utilized for receiving ambulance patients. 

To the left of the vestibule are found the record and interns' 
room. Here are stored case records and other matter of a 
similar nature; this room also serves as a physicians' office and 
conference room. Adjacent to the record and interns' room 
there is a room which has been designed for a library in which 
will be installed book shelves and library furniture and which 
will contain a number of modern works on medicine and surgery. 
The balance of the rooms on this floor are used as private offices 
by the resident physicians. 

The second floor is given up to bed rooms for the resident 
physicians with the exception of a large room which is at present 
used as a storeroom. 

For the exact location and size of rooms the reader is referred 
to the floor plans of the various pavilions. 

It is interesting to note that the first meeting of the Far 
Eastern Association of Tropical Medicine was held in this pavil- 
ion in March 1909. 

MEDICAL AND SURGICAL PAVILIONS. 

The medical, surgical and orthopedic pavilions are arranged in 
practically the same manner; for this reason only the surgical 
pavilion floor plans are reproduced. The three buildings have, 
on each floor, a large ward capable of holding sixty beds, and 
a smaller one intended for fifteen beds. 

The private pavilion contains a twenty-bed ward, a two-bed 
isolation ward, and sixteen private rooms on each floor. The 
first floor was occupied on March 25, 1911. 

The second floor of the obstetrical pavilion contains twelve 



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35 

private rooms, a twelve-bed ward, a nursery for newborn babies, 
a delivery room, a sterilizing room, and a physicians' waiting 
room. The doors of the nursery are solid and tight fitting so 
that patients on this floor are annoyed as little as possible by the 
crying of the babies. The first floor, or Filipina maternity, con- 
tains a thirty-bed- ward, a twenty-bed ward, an isolation room 
for infected cases, a delivery room, a babies' bath, and a phy- 
sicians' waiting room. 

All of these floors are provided with a diet kitchen, two bath 
rooms, toilet and slop room, linen room, and lockers for patients' 
effects. They are also provided with annunciators, telephones, 
and other modem conveniences. 

OPERATING PAVILION. 

This most important component part of the modern hospital 
is centrally located with reference to the other pavilions. The 
structure is 15,4 by 22.1 meters in size and is two stories high. 
The relative locations of the various units comprising the whole 
are shown on the floor plans of the building ; in this connection 
let it suffice to state that the various rooms are conveniently 
located and that the construction and plumbing are thoroughly 
sanitary in every respect. 

On the second floor are found two operating amphitheaters 
each with a seating capacity, for spectators, of about eighty 
and another room for fifty. Clinics are held here for the med- 
ical school students; in fact all ward surgery is done in these 
rooms. The floors of the whole pavilion are laid with 2-inch 
white hexagonal tile and floor comers are rounded to permit of 
thorough cleansing. The rooms are well supplied with modem 
surgical instruments and appliances and one has only to visit the 
pavilion any morning to realize the large amount of work that 
is being done there. 

A very valuable addition to the operating room equipment is the 
Carl Zeiss electrical illuminating device for operating theaters. 

Dr. McDill has kindly furnished the following description of 
this apparatus: 

The cloudy days so frequent during half the year in Manila interfere, 
to a very great degree, with clinical surgical instruction. One of the two 
new operating amphitheaters in the hospital is equipped with the Zeiss 
illuminating apparatus. 

The light is derived from a 30-amper search light, located in the 
corridor outside of the operating room, which projects a shaft of intense 
light through a hole in the wall after passing through a chamber containing 
distilled water; the water is kept cool by circulating between the chamber 
and a box at one side; this cools the light. 

The main shaft of light strikes a target containing eight distributing 



36 j 

mirrors (see illustration), each of which reflects its light to a correspond^! 
ing mirror attached to the ceiling, only five of these show in the illustra^ 
tion ; a horizontal distributing mirror, the same height as the operating 
table, is used to illuminate the field in perineal work. 

Each of these eight illuminating mirrors, one of which is for vertical , 
rays, reflects its pencil of light to a circle corresponding to its own size 
on the desired point on the operating table; hence, as all of these pencils ^ 
of light converge at one spot, the illumination effected is a seven-sided,-^ 
intensive illumination of the operative field and of any wound, no matter 
how deep. 

The illumination is free from heavy shadows and is uninterrupted when 
operators and assistants stand in the rays from even four of the mirrors. 

Spectators in the rear of the ampitheater can easily recognize anato- 
mical details that formerly were visible only to the operator. 

The advantages gained by the use of this apparatus are as valuable' 
to the operator as to the spectator; there being no noise, no heat and no 
eye-strain. There is no possibility of dust dropping into a wound from 
this apparatus and lastly it is easily kept in working order. 

On the first floor a fully equipped private operating room is 
found, which is open to any reputable surgeon. 

The whole pavilion is well lighted with electricity, plumbed 
for hot and cold water, supplied with electric call bells, telephones, 
and other conveniences. 

Each floor is provided with an up-to-date sterilizing room, con- 
taining the recognized apparatus of the modem sterilizing room. 

A room on the ground floor is fitted up for eye, ear, nose, and 
throat work and contains equipment of sufiicient quantity and 
quality to care for any class of disease belonging to this depart- 
ment in the best possible manner. 

Another very important aid to efficiency, located on the first 
floor of the surgical pavilion, is the X-Ray and Electro-Thera- 
peutic department. This work was taken up on January 10, 
1911, and until July 1, 1911, a total of 120 photographs had 
been taken, 90 fluoroscopic examinations made and 128 electrical' 
treatments given for carcinoma, epithelioma, lupus, exophthalmi^ 
goiter, blastomycosis, dhobie itch, acne, leukemia, and similar 
diseases. 

The equipment of this department includes a powerful inter- 
rupterless Roentgen ray machine ; high frequency apparatus for 
giving the various forms of electrical treatment ; a modern elec- 
tric diagnosis apparatus including sigmoidoscopes and explora| 
tory lamps ; diagnostic and treatment combinations for the elec- 
trical treatment of the kidneys, bladder, etc. 

Plans have been drawn for a complete mechano-therapy plant 
which, when completed, will supply every need along the line| 
of electro and hydrotherapy. The plans call for a two-sto.:^ 
building in which one floor shall be devoted to Russian and 



m 




TO OPERATING. 

-^^iLioN CORRIDOR 



SSAGlE 








1 






EI^ViroR 




ELE>^OR 




ll 



raIndas 



VERAlNDAS 



vTEl ROOMS I PRIVATE I ROOMS 



CORRIDOR SAat 



ATEl ROOMS 



RAlNOAS 




TOILET C 


1 




^,J 


J 




M. 1 



Scale Vioo m 



PLATE VIII 




Ij^BBm ^i^J ^^9^V H 



37 

Turkish baths, bath battery, hydrotherapy, the Schott treatment 
and exercises, and a complete Zander outfit with the necessary 
dressing rooms. 

The second floor to be occupied by the Roentgen ray, electrical 
diagnosis, and treatment departments. 

It is hoped to connect with it a modern cooled ward for the 
treatment of the various tropical neurasthenias and it is believed 
that much can be done to alleviate these annoying and persistent 
disorders with this method of treatment. The whole plant is, 
of course, to be under the management of trained experts in their 
different specialties. 

CULINARY DEPARTMENT. 

e 

Probably no other department of a hospital has to bear the 
brunt of so much fault finding and causes so much dissatisfaction 
as that concerned with the selection, cooking, and serving of 
patients' food. This, of course, is partly on account of the average 
patient's not knowing exactly what he does want or not wanting 
anything, but unfortunately the patient is often justified in com- 
plaining. Rarely does one find a hospital where so little cause 
for dissatisfaction along this line exists as in the Philippine Gen- 
eral Hospital. The writer has been in the hospital both as guest 
and patient, and is pleased to be able to state that there was 
no opportunity for finding fault with the quantity or quality of 
the food. Another feature which is a source of much satisfac- 
tion to the average person is that the housekeeper visits the 
private patients daily to ascertain what particular articles of 
food they desire. If not contraindicated their wants are carried 
out. 

The kitchen is two stories in height with no second floor thus 
giving abundant air space. It is 12.7 by 21.33 meters in size, 
is located at the rear of the present group of buildings and has a 
main kitchen and five side rooms. 

The kitchen proper contains a duplex double-faced range with 
six holes, four ovens, and four fire boxes. It is 1.92 by 4.72 
meters in size and possesses the necessary appurtenances for 
both plain and fancy cooking; steam heated, metal tea, coffee, hot 
water, and milk urns, are also conveniently placed here, the first 
three having«a capacity of 40 liters each and the one for hot milk 
a capacity of 15 liters ; another very necessary appliance found 
here is the steam table, the cooked food is placed in copper con- 
tainers and deposited on this table until such time as it is trans- 
ferred to the food trucks to be wheeled to the pavilions, when 
it is placed in other copper containers having hot water compart- 
ments; the containers with their contents are placed on the truck 



38 

thus insuring the food's being kept warm. There are also a 
copper steam rice cooker having a capacity, of 150 liters ; a steam 
soup kettle with a capacity of approximately 150 liters ; two steanl 
cereal and vegetable cookers holding 35 liters each, and two earth- 
enware steam vegetable cookers with a capacity of 24 liters each, 
all of which add materially to efficiency and despatch in the cook- 
ing and serving of food; copper pit)es carry the steam from all 
these cookers to the outside of the building. A large porcelain 
refrigerator is kept here to supply cold water and for the storage 
of smaller quantities of edibles. In addition this room contains 
the necessary serving tables, sinks, and other equipment of the 
modern kitchen. 

In the side rooms are to be found kitchen utensils and sup- 
plies among which are an electric ice cream freezer having a 
capacity of about 35 liters, an telectric bread cutter, a meat chop- 
per and a potato parer. In a small room adjoining the refrigerat- 
ing plant is located the dynamo which operates the brine pumps 
for the cold storage plant. The main refrigerator is 2.70 
by 3.18 meters in size and the cold store room adjoining is the 
same size. In this room are kept the perishable food sup^plies. 

DISPENSARY. 

The free dispensary, situated to the southeast of the hospital 
is an attractive two-story building 13.25 by 24 meters in size. 
It was one of the last of the present group of buildings to be 
completed, and was occupied on April 20, 1911. One has only 
to witness the number of persons passing in and out of it, how- 
ever, to realize what an important link it constitutes in the chain 
of buildings. 

On the lower floor are to be found, on the East side, two 
medical clinic rooms, a sterilizing room fitted with everything 
necessary for preparing the necessary dressings for the out 
patient obstetrical department, and a toilet room containing four 
flush closets of latest design. The floor is of hexagonal white 
tile. On the west side are located two surgical clinic rooms, a 
dressing room and toilet with accommodations similar to the one 
described above. The clinic rooms are provided with sinks and 
lockers. The balance of the floor is occupied by the pharmacy 
and a waiting room. The pharmacy is very hand'somely fitted 
up with polished native wood shelves and medicine cases, the 
bottles are provided with white enameled name plates upon which 
the names are printed in black lettering and are shelved accord- 
ing to size thus giving a very pleasing appearance. An average 
of about 200 prescriptions and 85 ward stock bottles are filled 
daily at the present time and the number is increasing constantly; 



^iJU 


x^ 


' / 


1 

TOILET \ 




B ! 1 





PHARMACY 



OFFICE ) 




SURGICAL 
CLINIC 



|l£ll 



MEDICAL 
CLINIC 



WAITING ROOM 



FEMALE 
.SURGICAL 



GlROUnd tloor plan 

DISPENSARY 




STUDENTS CLINICAL LABORATORY 



CLINICAL 
MICROSCOPY y 



UPPEIR PART OF 
WAITINa ROOM 



EYE, EAR, NOSE 
AND THROAT 
FREE CLINIC 11 



SCALE /lOO M. 



Second floor plan 

DISPENSARY 



PLATE XI 



39 

On August 7, a total of 278 prescriptions and 85 stock bottles 
'were filled; this amount of work taxes the working capacity of 
the pharmacy and of the force in charge. 

The entire second floor is given up to laboratory work. In a 
room at one end the greater part of the clinical microscopy of 
the hospital is being done by an employee of the Bureau of 
Science, the balance of the floor being used as a class room for 
the College of Medicine and Surgery, where the students are 
given practical instruction in laboratory methods and technique. 
The floor is equipped with modem laboratory apparatus. 

The building is equipped with gas, electricity, steam, and hot 
and cold water. 

The following extract from the report of the Superintendent 
throws additional light on the work of the free dispensary : 

The out patient or dispensary work at this hospital divides itself into 
three divisions, first the calls of Government^ beneficiaries, second the 
calls of private patients, third the patrons of the free dispensary. 

A word concerning the third class. The patrons of the free dispensary 
and clinic have been increasing daily. Up to January 1, 1911, a free 
dispensary and clinic were conducted at St. Paul's Hospital by the staff 
of the Medical College. After January 1, 1911, this clinic was transferred 
to the Philippine General Hospital and was divided into three sections. 
(1) The medical, tuberculosis, obstetrical, skin, children, neurology, and 
genito-urinary clinics, 'with from 50 to 150 patients daily, were held in 
the new dispensary and the sick came to the hospital proper to get their 
medicines at the pharmacy, which until May 1911, was conducted in a 
room in the operating pavilion. (2) The eye, ear, nose, and throat clinic, 
with 30 to 50 patients daily, was conducted on the lower floor of the operat- 
ing pavilion; and (3) the surgical clinic was, until June 16th, held in the 
dressing, sterilizing, and waiting rooms of the surgical pavilion. This third 
section was removed to the dispensary about the middle of June. 

Numerous important problems presented themselves in conducting this 
out dispensary work. The question of bottles; the hours which the busy 
physicians of the hospital could devote to this important work; the char- 
acter of the work, it being necessary to examine, diagnose, treat, and 
prescribe for the many patients within a reasonable period, which demanded 
the exercise of the highest skill and diagnostic ability; then the question 
of the vast quantities of medicine to supply 15,000 free patients annually, 
and the personnel to fill the prescriptions; questions as to whether the 
persons applying for free treatment were actually unable to pay; 
whether a small fee should not be charged for dressings and medicines; 
and how far charity should extend in providing those known to be in actual 
need with spectacles, crutches, trusses, wooden legs, glass eyes, and the 
like, some of which are yet to-be-worked-out problems. 

DORMITORY. 

The Dormitory or service building is three stories in height, 
the first two being constructed of reinforced concrete and the 
third of wood. Red tiles made locally of cement are used for 



40 

the roof. The building is located in the rear of the hospital 
grounds and accommodates the druggist, attendants, male pupil 
nurses, clerks, Chinese employees, and servants. It will house 
160 persons comfortably. Modern plumbing has been installed, 
ample locker rooms provided, and other conveniences supplied 
which make it admirably well suited for the purpose for which 
it is intended. 

NURSES' HOME AND NURSES. 

The nurses' home is one of the most attractive buildings of the 
entire group, being well proportioned both inside and out. It 
is situated to the northeast of the Administration Building and 
is a reinforced concrete structure, as are all of the pavilions, 
21.2 by 30.5 meters in size, with a cement tile roof and concrete 
floors. 

The home was not completed when the hospital was opened^: 
thus making it necessary for the nurses to occupy one of the 
pavilions in the hospital proper. After much delay it was finally 
occupied on March 20, 1911, and has proved to be admirably well 
suited to the needs of the nurses. 

There are six sleeping rooms on the first floor and twelve on 
the second. The rooms are large and with few exceptions open 
on spacious porches. Each room contains one, the larger rooms 
two, white enameled single beds with five-inch rubber tired 
wheels, a native hardwood dresser, a chiffonier, a writing desk, 
a bookcase, chairs, and bamboo tea tables. All are fitted with 
good-sized wardrobes, in the doors of which are built full length 
mirrors. The rooms are splendidly lighted having three electric 
lights each with ornamental fixtures and they all have electric 
fan attachments. The floors are built flush with those of the 
piazzas making it a very easy matter to roll the beds out on the 
piazza, in order that those who so desire may sleep there; it 
is needless to say that the majority of the nurses take advantage 
of this opportunity as it is not only comfortable but very con- 
ducive to good health. The rooms are fitted with louver doors 
which admit the maximum amount of air. In addition to these 
they have solid wooden doors and solid transoms which may be 
used to shut out sound from the corridors ; the nurses who neces- 
sarily have to sleep in the daytime find this a great convenience. 
Double doors open on the piazzas. 

The dining room on the first floor seats about thirty persons 
comfortably, at three large tables. The floor is laid with a 
native hardwood. Beside the tables the room contains a largd 
attractive sideboard, a buffet table, and chairs to match, all made 
from one of the native hardwoods resembling mahogany. It is 




IRST FLOOR PLAN 




SECOND F LOOR PLAN 

SER^ICC 




Third floor plan 



SERVICE 



PLATE XII 



VERANDA 




C R R I DOR 



CLQ - CLO. 



BED ROOM '"°i'r^ir^ BED ROOM BED ROOM BED ROOM 
ROOM 



TERRACE 



VERANDA 



Second floor plan 
nurses'home 



BED ROOM I BtD ROOM I BED ROOM I BED ROOl 



C O R R I DOR 




RECEPTION ROOM ■ BED ROOM 




V E R A N D A 



Scale /lOo m 



Ground floor plan 

NURSES'HOME 



PLATE XIII 



41 

well lighted by two triangular electric light chandeliers of 
modem design and two wall lights with ornamental brackets. 
Two sets of double doors open on the piazza. The tables are 
supplied with electric call bells. 

The reception room is large, airy, and tastefully furnished; 
has two double doors opening on the piazza, an arch opening into 
the main entrance, and two single doors opening into the corridor. 
It is well supplied with chairs, tables, and bookcases and con- 
tains a handsome couch. The furniture matches that in the other 
parts of the home. This room also contains a Concord Cabinet 
Grand piano, which it is needless to say is a source of much 
pleasure to the nurses. The lighting scheme here is in accord 
with that in the dining room. 

The equipment of the toilet rooms, of which there is one on 
each floor, is the most modern that could be purchased. The 
floors are laid with white hexagonal tile, which makes them not 
only pleasing to the eye, but sanitary as well. Each room con- 
tains two showers and one tub bath, three wash basins, two 
closets and one slop hopper, all of these appliances are made of 
porcelain and are thoroughly sanitary in construction. Both 
rooms are plumbed for hot and cold water and are electrically 
lighted. 

Each floor has a room for clean linen and drugs, as well as a 
soiled linen room. The second floor is also provided with a large 
lounging or sewing room. 

Marble steps were used in the construction of the stairway 
, connecting the first and second floors. 

All doors opening on the verandas are provided with trans- 
lucent shell panels thus giving the maximum amount of light 
when closed. 

On the third story four roof gardens have been constructed, 
making an ideal location in which to enjoy the balmy evenings. 

The kitchen and pantry are large and well ventilated and have 
hexagonal white tile floors. The pantry is well provided with 
shelves for dishes and drawers for linen, silver, and trays. The 
kitchen, pantry, and a section of the veranda are screened to 
prevent the entrance of flies and insects. A Leonard porcelam 
refrigerator, connected with the rain water dram, is kept on the 
veranda. Both rooms have hot and cold water plumbmg and 
sinks with drip boards. A large army range is used to do the 
nurses' cooking. A toilet for the servants constitutes a part of 
the first floor equipment. 

The front doors are made of scroll work iron and have a 
brass monogram of the letters N. H. attached. 



42 

The linen for the home was made to order in Japan and is 
stamped with the monogram N. H. as is the solid silver service. 

The nurses have their private telephone line in the building, as 
well as the hospital line, which may also be used for outside 
service. The housekeeper answers all calls and pays all bills for 
the nurses. Wednesday and Sunday evenings are termed "guest 
nights" though friends may be invited to dinner any evening. 
Dancing is permitted until 11 p. m. Tea is served from 3 to 5 
p. m. for the nurses going on or coming off duty. The day is 
divided into three shifts of eight hours, viz, 7 a. m. to 3 p. m., 
3 p. m. to 11 p. m. and 11 p. m. to 7 a. m. The nurses are left 
on the same duty for one month and unless there exists special 
reasons for changing, they are left in the same department inde- 
finitely, thus giving a nurse the opportunity to do the class of 
work she is especially interested in. The nurses of the Philip- 
pine General Hospital are given more privileges and shown more 
consideration in nearly every way than are those in the vast 
majority of hospitals. The reader must not infer from these 
statements that discipline is lax for good discipline is one of the 
strongest assets of the institution. 

The Filipina nurses as a whole are a grand success. They are 
quiet, gentle, patient, and are making rapid progress along the 
line of proficiency. One very frequently hears patients make 
the statement that they would as soon have a good Filipina nurse 
care for them as an American. The Filipina nurses are living 
in dormitories a short distance from the hospital. Eventually 
they will have a home of their own on the hospital grounds. A 
photograph of the six girls constituting the first class graduated 
from the hospital will be found on another page and with their 
native costumes they make a very attractive group. 

The male pupil nurses are rapidly acquiring the knowledge 
necessary to make them successful nurses and their ministrations 
will in the future undoubtedly prove to be a blessing to many of 
the sick of the Islands who have suffered heretofore without the 
care of either doctor or nurse. 

American nurses will have to be employed to act as head nurses 
for some time to come, but with the efficient class of nurses 
coming from the States and the good-sized classes of proficient 
native nurses, which will be graduated annually from this time 
on, the nursing outlook for the Philippines is most promising. 
When the hospital was occupied September 2, 1910, the nursing 
force consisted of 15 American and 56 pupil nurses. On June 
30, 1911, the nursing staff consisted of 18 American females, 5 
American males, 69 female and 38 male pupil nurses and 3 
graduate Filipina nurses. 



43 



BATES. 





Government 
pay patients. 


All other pay 
patients. 


MEDICAL AND SURGICAL CASES. 


Per day. 

K.OO 
3.00 
6.00 

10.00 


Perd 

Perw 

K per 
with 
city li 

By priv 
arra 
ment. 


P3.00 
4 00 


Class B wards 






Private rooms with bath 


12 00 


MATERNITY CASES. 




Class B wards _ _ 


4.00 
6.00 
7.00 

1.50 

1.00 
2.00 
4.00 

Per week. 
40.00 
30.00 
20.00 

Nothing 

Nothing 
Nothing 
Nothing 

Nothing 
Nothing 

Nothing 
Nothing 

Nothing 
Nothing 
Nothing 
Nothing 

Nothing 

Nothing 
Nothing 

Nothing 

Nothing 
Nothing 

.40 
1.00 
.50 


5 00 


Private rooms with two beds each person. 


7 00 


Private rooms with one bed 


8 00 


SPECIAL RATES FOR CHILDREN. 

Well children up to 6 years of age kept in children's nursery 

Sick children up to 14 years of age. 


2.00 
1.50 




3.00 






FEES FOR SPECIAL NURSES. 


zek. 
60.00 




40.00 




30 00 


(Note. The hospital does not obligate itself to furnish special nurses 
but will do so when practicable, if they are desired.) 






in the 

mits. 

10.00 




20.00 








nge- 
.60 




1.00 


LABORATORY FEES (Bureau of Science) . 


3.00 




6.00 


Other examinations. (Special list of prices furnished when re- 
quired.) 

All fees for biological and chemical examinations must be paid at 
the office. No officer or employee of the Bureau of Science is 
allowed to accept private fees for laboratory work. 

RADIOGRAMS. 


10.00 




20.00 




20.00 




30.00 


FLUOEOSCOPE EXAMINATIONS. 

Each 


5.00 


Electrical treatments will be administered onlx upon physicians' 
prescriptions, and charges will be made at the f ollowmg rates. 


2.60 




5.00 


High frequency, ultraviolet, de Arsonivalization, Fulguration and 


6.00 


Cystocopic, sigmoidoscopies and similar examinations and treat- 


6.00 




5.00 


AU fees for electrical treatment are payableto the Cashier at the 
office. Under no circumstances will the operator be allowed to 
receive fees. 

MISCELLANEOUS CHARGES. 


.40 




1.60 




.50 


Medicines and articles of diet not on regular lists will be charged 
for extra. 





44 

STATISTICAL. 

On account of the fact that the hospital has been in operation 
for so short a period of time statistics would not be representative. 
No attempt will be made, therefore, to go into detail on this 
subject. 

Unless otherwise stated reports given cover the period from 
September 1, 1910, to June 30, 1911. 

CAPACITY. 

Six ward floors of 50 beds each 300 

Three private floors of 42 beds each 126 

Filipina Maternity, 30 adults, 20 sick children 50 

Total 476 

This computation does not take into account the number of 
new-born infants on either floor of the maternity pavilion. More 
than fifty patients can be accommodated on each of the six ward 
floors without undue crowding. 

The hospital offers an excellent clinical field for medical 
students as 200 beds are always available for teaching purposes 
and material may be selected from approximately another 100 
beds if it is desired to do so. 

Total number of physicians, nurses, and employees in the hos- 
pital, including male and female training schools, on September 

22, 1911, 352. 

Expenditures and obligations. 

Total appropriations for buildings and improve- 
ments to grounds ¥=1,080,899.09 

Expended for equipment to June 30, 1911 153,447.25 

Estimated outstanding obligations for equip- 
ment June 30, 1911 50,000.00 

Total 1,284,346.34 

Cost per bed. 

Cost' of buildings and equipment ^1,284,346.34 

Total number of beds 476.00 

Cost per bed -. 2,698.20 

Financial statement. 

APPROPRIATIONS. 

Original appropriation, Act 1954 P780,000.00 

Transfer from Medical School appropriation, 

Act 1954 10,000.00 

Appropriation for completion and equipment. 

Act 1902 203,581.29 

Transfer from appropriation for plumbing, 

Act 1954 30,375.28 

Transfer of funds authorized by the Secretary 

of the Interior, December 28, 1910 56,942.52 

Total 1,080,899.09 



45 



BUILDING EXPENDITURES TO JUNE 30, 1911. 

Additions and alterations '?48,737.21 

Ambulance garage 9,672.35 

Conduit 35,636.32 

Construction main buildings 636,514.34 

Dispensary 44,434.82 

Drafting and blue prints 32,772.26 

Foundations .......'. 1,284.99 

Filling _ 38,181.72 

Inspection of work 5,105.80 

Installation of power, heating, light, and cable.. 63,917.66 

Miscellaneous 14,248.83 

Sewer system 11,234.70 

Balance 14,935.60 

Total 1,080,899.09 

MAINTENANCE EXPENSES. 

September 1, 1910, to June 30, 1911. 

Salaries and wages ?63,569.38 

Commutation of subsistence 5,323.13 

Subsistence supplies 67,197.20 

Light 6,195.81 

Telephone, rent 868.79 

Coal, oil, gas, and steam 4,782.66 

Laundry, hospital 9,604.35 

Laundry allowance 1,617.42 

Transportation 1,981.63 

Medicines, medical and surgical supplies 18,395.62 

Repairs 349.04 

Maintenance, grounds 3,802.72 

Office supplies 1,138.90 

Miscellaneous supplies 13,618.94 

Incidentals 1,564.12 

Salaries, laundry allowances, and subsistence of 

pupil nurses 30,221.20 

Hospital equipment 153,447.25 

Improvement on building 572.39 

Total 384,250.55 

COST OF SUBSISTENCE. 



Average cost per day. 


Average num- 
ber subsisted 
per day. 


Average coat 

per person per 

day. 


1910. 


P95.949 
116.989 
133.1413 
179.44 

204.65 
257. 117 
253.7838 
269.4493 
316. 1841 
326.7353 


116 
144 
175 
180 

224 

316 

332.6 

354.7 

399.4 

421.5 


P0.827 
.8124 
.7608 
.9968 

.9135 

.8136 

.763 

.7596 

.7891 

.7751 








1911. 




March -- --- 


April 


May 


June 




216.24 


266.31 


.82109 



46 

The following table illustrates the steady increase in the num- 
ber of patients at the end of each month : 

Patients. 

September 30, 1910 43 

October 31, 1910 58 

November 30, 1910 60 

December 31, 1910 .- 65 

January 31, 1911 132 

February 28, 1911 214 

March 31, 1911 204 

April 30, 1911 215 

May 31, 1911 291 

June 30, 1911 284 . 

July 31, 1911 324 

August 31, 1911 353 

Smallest number of patients in hospital at one time 

September 2, 1910 (opening day) 10 

Largest number of patients in hospial at one time 

September 6, 1911 354 

Patients admitted by Bureaus September 3, 1910, to June SO, 1911. 



Bureau. 


1 


O 


1 
1 


1 


s 

1-5 


1^ 


1 




1 


1-5 


S 




8 
1 


34 
3 
1 


63 

7 

1 
1 


73 
3 
6 


196 
6 
8 
3 
1 
7 
6 
12 


267 
4 
3 


306 
2 
8 
2 


305 
3 


416 

4 

. 2 


434 
8 
2 
1 


2,100 
41 
21 
8 
3 




Audits 


Coast and Geodetic Survey 




Civil Service 




2 
7 
4 
10 


Constabulary 


6 


9 
10 
18 


9 
8 
IB 


5 
4 
20 


5 

8 
15 


17 


10 
3 
29 


10 
6 

18 
4 

18 
8 
4 
1 
6 

16 

2 

...... 

11 
10 
1 
3 
36 
1 
1 


77 
50 
161 






7 


Provincial Governments 


Health 


3 
3 


7 


13 
3 
1 
1 
4 

10 
2 
4 
1 

12 
3 
2 
2 

28 


7 
2 

1 


9 
6 
6 


12 
...... 


9 

2 

\ 2 




16 
7 
6 
1 
6 

12 
8 
2 
2 

21 
7 
3 
2 

32 
1 


103 
34 
24 


Internal Revenue 




Code Committee 






Lands 


4 
10 


6 
13 
2 
4 
1 
10 
4 
6 
6 
14 
8 
1 


2 
8 
4 
2 
1 
9 
...... 

4- 
10 


1 

15 

1 

...... 

11 

4 

..... 

25 


2 

7 
1 
3 
1 
15 
1 
3 
...... 

3 


2 

7 
5 
7 
3 
8 
3 
2 
6 
27 
1 


2 
9 
6 
2 

"""io' 

3 

2 

1 

17 

1 


33 
107 
30 
27 
12 
111 
36 
22 
20 
197 
11 
4 




Posts 


Printing 


3 


Prisons 


Public Works 


4 

1 


Science 


Supply _ 






Municipal Board _ - 


12 
1 


Executive 


Assembly 


1 


1 


















Total 


68 


132 


191 


162 


315 


365 


423 


409 


589 


590 


3,289 





47 
Patients admitted from September 3, 1910, to June 30, 1911. 

Classification by residence. 



Residence. 


1 

& 
m 


1 


1 
1 


1 
1 


1 


1 


1 


1 

< 


1 


1 


& 


City of Manila 


51 


108 


163 
2 


130 
2 


268 
1 


230 
1 


375 


358 


489 

2 
2 


470 
1 


2,642 

9 
2 


PROVINCES. 

Albey _ _ 


Ambos Camarines ___ . 










Antique.- _ 


















1 


Bataan 




1 


2 

1 
2 


2 
2 
4 
1 
1 


2 
4 
6 


~"iT 

8 

1 

6 


1 

2 
9 


3 
1 

14 


3 
4 
4 
1 
13 
1 


5 

9 

22 

1 
9 

1 


19 

101 
72 




1 


Bulacan..- 


Capiz 


1 


Cavite 


2 

1 


2 


6 

1 


3 

1 


50 
5 


Cebu- ___ 




Corregidor 










1 


1 


Ildcos Norte 












2 


1 


1 
1 


...... 


4 


IlocosSur 




1 






1 


4 
1 


10 


Iloilo 












1 


Isabela 






















Lasuna.. 




2 

1 


2 






3 
1 
2 


6 


""l 


9 


17 


39 


La Union 


1 


4 


Leyte __ ____ _ 












3 


Mindoro 1 






1 


1 


1 


8 
...... 


1 
1 
3 

1 


11 


Moro 1 












3 














1 




6 


Negros Occidental ___ 








2 


NuevaCaceres 


1 
















2 






1 


S 
1 
4 
2 


5 

1 
1 
1 




1 


2 


7 


23 


Neeros Oriental . ,. 






2 


Palawan 










3 








5 






2 


4 




3 


7 


2 


28 




1 
1 
6 


1 




3 
6 


3 
4 
1 
2 
...... 




g- 


1 
17 

1 


16 


4 
13 


4 
29 

1 


2 
27 


19 


Kizal 


130 


Samar _ _. 


3 
















2 


Tarlac . 




1 
1 




1 

1 

2 






1 
1 
1 


...... 

3 

1 

1 


2 

4 

1 


6 




1 
1 


2 


U 






12 










1 


Nueva Vizcaya _ _ _ 


















3 


















1 


























63 


132 


191 


,162 


315 


365 


423 


409 


589 


590 


3,239 







Patients admitted monthly by nationalities. 

From September 3, 1910, to June 30, 1911, inclusive. 



Months. 


Ameri- 
can. 


Fili- 
pino. 


Span- 
ish. 


Eng- 
lish. 


Other 
Euro- 
peans. 


Chinese. 


Japa- 
nese. 


Other 
Asiatics. 


Total. 


September 


19 
57 
78 
69 
90 
69 
98 
82 
130 
123 


40 

69 

95 

88 

206 

296 

311 

303 

432 

448 




2 
3 
9 








2 
1 

1 


63 


October . 


1 

4 

1 

12 

t 
9 
9 
11 




1 
1 
1 
2 
1 
5 
3 
4 




132 


November 


2 
3 
2 


1 


191 
162 


January 




2 
2 
2 
5 
10 
5 


1 
2 


315 


February 


1 
2 
4 
3 
3 


365 


March 


2 
3 


423 


April 




409 


May. 


1 


589 


June 




590 












Totals 


805 


2,288 


54 


27 


12 


18 


27 


8 


3,239 



48 



Patients admitted September 3, 1910, to June SO, inclusive 
ClasBification by ag:es. 



Agea. 


1 
1 


1 

o 
O 


1 
1 


i 
1 


H3 


2 
1 


•a 




1 


c 
p 


J 


Under 30 days . 


1 


2 

4 

1 

-2 

2 

1 

7 

37 

21 

39 

11 

1 

1 

1 


1 

1 

2 

4 

1 

3 

10 

43 

45 

60 

19 

4 

2 


1 

5 

3 

2 

3 

4 

12 

25 

34 

42 

13 

3 

3 

2 


1 

3 

1 

3 

2 

16 

20 

50 

66 

94 

31 

10 

11 

1 

1 


2 
5 
3 
4 
14 
18 
63 
49 
64 
57 
36 
17 
16 
4 


1 

11 

9 

9 

10 

10 

35 

69 

65 

97 

46 

24 

8 

6 

1 


1 
13 
3 

10 

11 

12 

34 

75 

62 

106 

34 

21 

9 

2 

1 


4 

14 

8 

9 

12 

20 

72 

101 

87 

127 

62 

17 

26 

4 

1 

1 

1 

24 


14 

18 

21 

23 

63 

95 

84 

120 

69 

28 

12 

6 

3 

""so" 


14 


30 days to 1 year 


70 


1 to2 years 




44 


2 to 5 years-, 


1 


62 
76 




10 to 15 years 


1 
9 
19 
16 
11 
6 


108 


15 to 20 years 


315 


20 to 25 years-. 


663 


26 to 30 years --- 


632 


30 to 40 years 


743 
315 


40 to 50 years.. 


60 to 60 years .-. 


60 to 70 years 




88 


70 to 80 years 




26 


80to 90 years 


1 




90 to 100 years. 








1 


OverlOOyears 




1 
















2 


6 


10 


16 


23 


22 


15 


148 






Totals 


63 


132 


196 


162 


315 


365 


423 


409 


589 


690 


3,239 



Patients admitted monthly according to service and sex from September 
3, 1910, to June 30, 1911, inclusive. 



Service. 


1 

E 
& 

CO 


u 

O 


1 
1 


1 

1 


1 


1 


X 




i 


s 


1 




25 
35 

1 


37 
73 
15 
3 

4 


69 
106 
15 
3 
9 


75 
54 
12 
9 
12 


123 

143 

26 

17 

6 


170 

131 

36 

10 

18 


201 

152 

31 

14 

25 


186 
138 
40 
18 
28 


267 
198 
36 
46 
43 


242 
183 
61 
66 
48 


1,382 

1,212 

262 


Medical 






185 


Children 


2 


195 








63 


132 


191 


162 


315 


365 


423 


409 


589 


590 









Male - _ , 
Female. 



48 
15 


92 

40 


120 
71 


118 
44 


215 
100 


246 

120 


277 
146 


268 
141 


400 
189 


364 
236 


63 


132 


191 


162 


316 


366 


423 


409 


589 


590 



2,137 
1,102 



3,239 



Monthly report of the Clinical Division for October, 1911. 

Total number of admissions 638 

Total number of discharges (including transfers, etc.).. 626 

Total number of births 27 

Total number of deaths 38 

Total hospital days 9265i 

Average hospital days 14| 

Admissions) ^em^aie.":;." 229 } '^^^al ~^ 

Medical 303 

Surgical I99 

Eye, ear, nose, etc 92 

Obstetrics 44 



49 

The Electro-Therapeutic Department. 

The X-ray department was opened for use January 10, 1911. 
were made as follows : 



Skiagrams 





Extre- 
mities. 


Abdo- 
men. 


Chest. 


Head. 


Total 


January ._ 


12 
4 
8 
6 
7 
8 


3 
4 
1 
2 
10 
8 


1 


2 
2 
9 
4 
3 
14 


18 
10 
28 
12 


February 


March 


10 


April 


May 






June. ___ . _ , _ 


2 


22 




Totals 


45 


37 


4 


34 


120 





Pathological Laboratory. 

Urine examinations : 2,852 

Feces examinations 1,866 

Sputum examinations 586 

Blood examinations 274 

Pus examinatipns 18 

Stomach contents examined 14 

Serums and cultures examined ^ 16 

Exudations, (acne, ear, etc.) examined) 28 

Total 5,654 

Prescriptions and ward orders were filled by months as follows: 





Pres- 
criptions. 


Ward 
orders. 


Totals. 


1910. 
July . 


689 
825 
729 
755 
964 
948 

2,300 
2,824 
3,788 
3,478 
4,355 
3,938 


560 
461 
502 
629 
920 
1,064 

1,669 
1,697 
2,092 
2,193 
2,292 
2,309 


1,259 
1,276 






1 231 




1,404 




1,884 




2,002 


1911. 


3,969 




4,621 


March 


6,880 


April 


5,671 


May --- - 


6,647 




6,247 








25,613 


16,370 


41,983 



July and August statietics are for the Civil Hospital. 

Largest jiumber of prescriptioni and ward orders filled in one day, 322. 

107997 1 



50 

FREE DISPENSARY. 
Annual report for the fiscal year, 1911. July, 1, 1910, to June SO, 1911. 





July, 
1910. 


Au- 
gust, 
1910. 


Sep- 
tem- 
ber, 
1910. 


Octo- 
ber, 
1910. 


No- 
vem- 
ber, 
1910. 


De- 
cem- 
ber, 
1910. 


Number of patients: 

Total 


1,805 

1,095 

710 

875 

719 

211 

442 

498 

195 

63 

38 

386 

160 

24 

24 

3,016 


1,938 

848 

1,090 

1,073 

661 

204 

422 

680 

171 

66 

26 

378 

254 

26 

25 

3,091 


2,051 

833 

1,218 

1,121 

676 

264 

470 

666 

166 

60 

29 

379 

229 

29 

34 

3,139 


2,292 

917 

1,375 

1,174 

866 

252 

476 

608 

211 

62 

42 

496 

346 

34 

17 

3,849 


2,185 

793 

1,392 

1,242 

770 

173 

424 

666 

168 

62 

26 

616 

271 

42 

22 

3,487 


1,744 


First visit _ _ 


637 


More than one visit 


1,107 


Males • _ 


1,004 




620 


Children 


120 


Medical clinic 


376 




621 




109 


Skin clinic 


34 


Obstetrical clinic 


28 




369 




163 


Neurology clinic 


31 




23 




2,394 








Jan- 
uary, 
1911. 


Feb- 
ruary, 

1911. 


March, 
1911. 


April, 
1911. 


May, 
1911. 


June, 

1911. 


Grand 
total. 


Number of patients: 

Total 


1,112 

535 

527 

642 

377 

93 

297 

168 

81 

55 

31 

227 

207 

19 

37 

2,270 


1,467 

749 

718 

778 

550 

139 

437 

265 

126 

50 

23 

300 

215 

30 

31 

2,824 


1,908 

986 

922 

959 

740 

209 

619 

360 

200 

69 

33 

377 

206 

26 

39 

3,696 


1,892 

964 

1,928 

971 

743 

178 

639 

442 

163 

41 

20 

322 

221 

15 

29 

3,343 


2,976 

1,458 

1,617 

1,569 

1,108 

298 

924 

643 

283 

49 

30 

422 

662 

27 

35 

4,257 


2,966 

1,610 

1,456 

1,523 

1,098 

846 

939 

716 

336 

59 

38 

293 

627 

21 

33 

3,813 


24,336 


First visit.. 


11, 376 


Males ... '-1!.^.-'.''"!'" 


12,960 
12,931 




8,928 


Children 


2,476 




6,466 


SurErical clinic 


6,187 




2,207 


Skin clinic 


630 


Obstetrical clinic 


363 




4,469 


Eye, ear, nose and throat clinic 


3,351 
328 


Genito-urinary clinic . ... 


349 


Number of prescriptions filled 


39,178 



Note.— Reports for July and Aueust are Civil Hospital statistics. 

Monthly report of free dispensary, for the month of October, 1911, 

Number of patients: 

Total 6,320 

First visit 2,529 

More than one visit 3,791 

Males 3,312 

Females 2,273 

Children 735 

Medical clinic 1,890 

Surgical clinic 1,948 

Children clinic 338 

Skin clinic 254 

Obstetrical clinic 47 

Tuberculosis clinic 461 

Eye, ear, nose, and throat clinic 1,260 

Neurology clinic 54 

Genito-urinary clinic , 68 

Number of prescriptions filled 6,146 

O 




ADMINISTRATION PAVILION. 




MEDICAL CONSULTATION OFFICE. ADMINISTRATION PAVILION. 
PLATE XI v. 




VESTIBULE, ADMINISTRATION PAVILION. 





MAIN OFFICE, ADMINISTRATION PAVILION. 
PLATK X\ . 




COURT FACING FRONT OF ADMINISTRATION PAVILION. 




COURT FACING REAR OF ADMINISTRATION PAVILION. 
PIjATE XVI. 




GARAGE AND AMBULANCES. 



yy^^^.. , ...rr?!35?5 




SURGICAL PAVILION. 
I'LATK XVII. 




PRIVATE ROOM. 




!»^\ .-?•■'-' ^ ■?' -'•s :«'!.:: 




FEMALE WARD. 
PLATE X\ 111. 




CORRIDOR. 




COURT AND CORRIDORS. 
PLATE XIX. 




COURTYARD BETWEEN PAVILIONS. 




ACACIA TREES IN HOSPITAL GROUNDS. 




OPEN COURT AT REAR OF OPERATING PAVILION. 




OPERATING PAVILION. 
PLATi: XXI. 




CORRIDOR, OPERATING PAVILION. 




ONE OF THE STERILIZING ROOMS. 
PLATE XXII. 




ONE OF THE OPERATING AMPHITHEATERS, SHOWING PORTION OF ZEISS 
ILLUMINATING APPARATUS. 




NINETEEN BABIES LESS THAN TEN DAYS OLD. THREE PAIRS TWINS. 

PHILIPPINE GENERAL HOSPITAL, 1911. 

PLATE XXIII. 




REAR VIEW OF KITCHEN. 




r -; ' ^^.-- r— ---_■ -f" ■ ' - «^J 



.'^^^ 




INTERIOR OF KITCHEN. 
PLATE XXIV. 







FREE DISPENSARY. 
Showing patients awaiting treatment. 




NURSES' HOME. 
PLATE XXV. 




ROOM IN THE NURSES' HOME. 




PIAZZA, NURSES' HOME. 
PLATE XXVI. 




PART OF DINING ROOM, NURSES' HOME. 




RECEPTION ROOM, NURSES' HOME. 
PLATE XXVII. 










I 







'" — --'•^.. 



PRELIMINARY CLASS. ADMITTED OCTOBER 1, 1911. 









chief nurse and female pupil nurses. four graduates, front row. 
PIjATK .\x\iii. 




CHIEF NURSE AND MALE PUPIL NURSES. 




FIRST GRADUATING CLASS. 

rr.vrr: x.vix. 



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